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Frühe Optimierung der Antibiotikatherapie durch den schnellen Nachweis von Erregern und Empfindlichkeit

Gesundheitsökonomische Aspekte

Early optimization of antibiotic therapy through rapid detection of pathogens and sensitivity

Health economic aspects

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Zusammenfassung

Einführung

Schwere Infektionen erfordern frühe Optimierung der Antibiotikatherapie. Seit 2016 ermöglicht eine neue Methode Erregerdifferenzierung und Resistenztestung positiver Blutkulturen in weniger als 8 h. Ziel dieser Arbeit war, die ökonomischen Effekte der schnelleren Verfügbarkeit auf nationaler Ebene zu untersuchen und in einem Krankenhaus zu validieren.

Material und Methoden

In einer Literaturrecherche wurden der klinische und ökonomische Nutzen adäquater Therapie sowie die Rate der initial inadäquaten antibiotischen Therapie (IIAT) in der Indikation „Sepsis und Blutstrominfektionen“ ermittelt. Die Mittelwerte der gepoolten Studien wurden mit den Fallzahlen in Deutschland (Datenjahr 2015) für alle Fälle, in denen Sepsispatienten mit codiertem Keim und Intensivaufenthalt zu finden waren, in ein ökonomisches Modell integriert, das anschließend in einem Krankenhaus überprüft wurde.

Ergebnisse

Die Analyse von 14 Studien mit 6408 Patienten ergab eine mittlere Rate von 27,3 % IIAT. Aus 8 Studien (n = 2988) wurde eine durchschnittliche Verweildauer(VWD)-Einsparung von 4,7 Tagen bei adäquater Initialtherapie im Vergleich zu einer IIAT ermittelt. Mit einer VWD-Reduktion von 3,7 Tagen ließen sich im theoretischen Modell pro Fall im Mittel 1539 € einsparen. Eine konservative Variante mit einer IIAT von 20 % und VWD-Einsparungen von 2,5 Tagen ergab noch immer eine durchschnittliche Einsparung von 201 € pro Fall. Von 146 Fällen in der Validierung hatten 68 % eine positive Blutkultur. In 61 % der geprüften Fälle wäre eine Anpassung der Therapie erforderlich gewesen (35 % IIAT, 26 % Deeskalation). Nach Abzug der Kosten für den Test bei 60 Patienten ergaben sich mögliche Einsparungen von insgesamt 122.112 €; pro Fall über 2000 €.

Zusammenfassung

Sowohl die Ergebnisse des ökonomischen Modells als auch die Auswertung in einem Krankenhaus zeigen, dass eine schnelle adäquate Antibiotikatherapie ökonomisch günstig ist. Die Optimierung der antibiotischen Therapie durch einen frühzeitigen Nachweis des Erregers sowie der Empfindlichkeit mittels MHK stellt eine Möglichkeit dar, trotz hoher Kosten für die Diagnostik in der Klinik Einsparungen zu erzielen. Potenziale sollten krankenhausindividuell mittels systematischer Fallreviews ermittelt werden.

Abstract

Introduction

Severe infections require early optimization of antibiotic therapy. Since 2016, antibiotic susceptibility results with minimum inhibitory concentrations (MIC) direct from positive blood cultures are available in less than 8 h using a new diagnostic system. The aim of this study is to investigate the economic effects of a rapid availability of antibiotic susceptibility in Germany and to validate these theoretical results in a German hospital.

Materials and methods

In the context of a literature search, the clinical and economic benefit of an adequate therapy as well as the rate of the initially inadequate antibiotic therapy (IIAT) were determined for sepsis and bloodstream infections. In addition to the weighted average of the pooled studies, the case numbers in Germany (data year 2015) of all DRGs for sepsis patients with coded pathogen and ICU stay were integrated into a theoretical economic model that was subsequently validated in a German hospital.

Results

The analysis of 14 studies with a total of 6408 patients showed an average weighted rate of 27.3% IIAT. From a total of 8 studies (n = 2988), an average weighted length of stay (LOS) saving of 4.7 days was determined with adequate initial therapy compared to an IIAT. In the theoretical model, an average of € 1539 per case could be saved with a possible LOS reduction of 3.7 days. A conservative scenario with an IIAT of 20% and LOS reduction of 2.5 days still resulted in an average saving of € 201 per case. In the hospital-individual model, 68% of 146 cases had a positive blood culture. In 61% of the examined cases an adjustment of the therapy would have been necessary (35% IIAT, 26% de-escalation). After deducting the cost of the test for 60 patients, the total potential savings amounted to € 122,112, which is over 2000 € per patient.

Conclusion

A fast adequate antibiotic therapy was economically advantageous both in the economic model and in the real-life evaluation. The optimization of antibiotic therapy by early pathogen detection and MIC-based susceptibilities represents a possibility to achieve savings despite the high costs for diagnostics in the clinic. Particularly noteworthy is the optimization through de-escalation. The potential for each hospital should be identified through systematic case studies.

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  1. inspiring-health GmbH, Waldmeisterstr. 72, 80935, München, Deutschland

    M. Wilke, K. Worf, W. Heinlein & T. Kast

  2. Werner Forßmann Krankenhaus, Klinikum Barnim GmbH, Eberswalde, Deutschland

    K.-F. Bodmann

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M. Wilke erhielt Honorare von Accelerate Diagnostics, Inc., Curetis AG, Abbott Diagnostics, Pfizer Pharma PFE GmbH. M. Wilke ist CEO der inspiring-health GmbH und hält Anteile. T. Kast und K. Worf erhielten Fördermittel von Accelerate Diagnostics, Inc. W. Heinlein erhielt Fördermittel von Accelerate Diagnostics, Inc., Curetis AG, Abbott Diagnostics und Pfizer Pharma PFE GmbH. W. Heinlein hält Anteile an der inspiring-health GmbH. K.-F. Bodmann erhielt Honorare von Accelerate Diagnostics, Inc., Abbott, Astellas, Basilea, Bayer, Correvio, Cubist, Infecto Pharm, MSD, Novartis, Pfizer und Thermo-Fisher Scientific.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wilke, M., Worf, K., Heinlein, W. et al. Frühe Optimierung der Antibiotikatherapie durch den schnellen Nachweis von Erregern und Empfindlichkeit. Med Klin Intensivmed Notfmed 115, 420–427 (2020). https://doi.org/10.1007/s00063-020-00680-5

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