Table 2

Variables used in estimating the cost of MRO screening and treatments

VariableEstimate (95% CI)Comment/source
Cost of screening for pathogens
 Usual screening: microbiology test and PCR$82 ($58 to $107)Elliott et al 5
 WGS: microbiology test, PCR and WGS$437 ($309 to $565)Elliott et al 5
 Cleaning and extra nurse time per detection*$122 ($90 to $155)Elliott et al 5
 PPE per day in isolation$50 ($35 to $65)Otter et al 18
 Closed-bed day$246 ($151 to $342)Page et al 25
Cost of antibiotic treatment per infected patient
 MRSA (vancomycin)‡$580 ($409 to $750)SA guideline26/hospital pharmacy
 ESBL Escherichia coli (meropenem)§$321 ($227 to $416)Wozniak28 and hospital pharmacy pricing
 VRE (linezolid and daptomycin)¶$3433 ($2424 to $4443)
 CPE (colistin+meropenem** and gentamicin/amikacin††)$2920 ($2061 to $3778)Pharmacy infection network27 and hospital pharmacy pricing
 CRAB (colistin+tigecycline‡‡ and colistin+meropenem**)$3199 ($2258 to $4139)Viehman et al 29 and hospital pharmacy pricing
MRSA
 Colonisation LOS29.2 (16.4 to 51.9)Kirwin et al 20
 Infection LOS42.7 (23.6 to 77.2)Kirwin et al 20
ESBL E. coli
 Colonisation LOS16.0 (8.0 to 31.0)Suzuki et al 23
 Infection LOS33.0 (18.0 to 64.0)Suzuki et al 23
VRE
 Colonisation LOS15.0 (9.0 to 30.0)Tan et al 30
 Infection LOS34.0 (29.6 to 38.4)Lloyd-Smith et al 21
ESBL Klebsiella pneumoniae
 Colonisation LOS16.0 (8.0 to 31.0)Suzuki et al 23
 Infection LOS33.0 (18.0 to 64.0)Suzuki et al 23
CPE
 Colonisation LOS12.0 (3.0 to 21.0)Rodriguez-Acevedo et al 22
 Infection LOS29.0 (22.7 to 35.3)Zhen et al 24
CRAB
 Colonisation LOS9.0 (6.0 to 22.0)Álvarez-Marín et al 19
 Infection LOS21.5 (11.5 to 42.8)Álvarez-Marín et al 19
Closed-bed days§§
 MRSA35.2 (16.3 to 69.4)Kirwin et al 20
 ESBL E. coli 16.6 (3.6 to 30.4)Suzuki et al 23
 VRE13.8 (10.0 to 16.9)Lloyd-Smith et al 21
 ESBL K. pneumoniae 16.6 (3.6 to 30.4)Suzuki et al 23
 CPE14.5 (11.4 to 17.6)Assumption¶¶
 CRAB10.8 (5.8 to 21.4)Assumption¶¶
  • *Cleaning is for decontamination of the room and nursing time is for isolating the patient, contact precautions and so on.

  • †Australian study/data.

  • ‡Flucloxacillin administered at 2 g intravenously 6-hourly initially and vancomycin at 2 g.

  • §Meropenem administered at 1.0–2 g three times daily.

  • ¶Linezolid administered at 2×0.6 g for 14 days and daptomycin 0.6 g daily.

  • **Colistin administered at 275 mg for 14 days and meropenem administered at 1.0–2 g three times daily.

  • ††Gentamicin administered at 5–7 mg/kg for 14 days and amikacin administered at 15 mg/kg.

  • ‡‡Colistin administered at 275 mg for 14 days and tigecycline administered at 100 mg followed by 50 mg every 12 hours.

  • §§Closed-bed days were estimated by excess LOS for infections by each species.

  • ¶¶Extra LOS was assumed to be 50% of the infection LOS.

  • CPE, carbapenemase-producing Enterobacterales; CRAB, carbapenem-resistant Acinetobacter baumannii; ESBL, extended spectrum beta-lactamases; LOS, length of stay; MRO, multidrug-resistant organism; MRSA, methicillin-resistant Staphylococcus aureus; PPE, personal protective equipment; SA, South Australia Health; VRE, vancomycin-resistant enterococci; WGS, whole-genome sequencing.