ObjectiveTo analyze the cost and performance of five methods for detection of carbapenemase-producing Enterobacteriaceae (CPE), including PCR (method A), Carba NP test (method B), ultraviolet spectrophotometry (method C), modified carbapenem inactivation method (mCIM, method D), and loop-mediated isothermal amplification (LAMP, method E).MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were searched using the computer regarding literature on detection of CPE with the same or similar designs, same objectives, and independent results. The search was limited between May 2009 and May 2019. Data on the cost and detection performance of all five methods were extracted, and the four special indexes for laboratory tests, such as sensitivity, specificity, simplicity, and rapidity in the utility were quantified as specific values; subsequently, the cost-effective analysis (CEA), cost-utility analysis (CUA), and multi-attribute utility theory (MAUT) in the detection economic analysis were used to conduct health economics evaluation of five detection methods for CPE.ResultsThe cost of methods A, B, C, D and E were 210.00 yuan, 22.00 yuan, 10.50 yuan, 6.00 yuan, and 60.00 yuan, respectively. The C/E of CEA for the above five methods were 210.00, 22.96, 10.66, 6.14, and 60.00, respectively. The C/U of CUA for the above five methods were 302.16, 32.13, 19.30, 11.13, and 80.00, respectively. The MAUT value of the above five methods were 42.56, 5.00, 2.54, 1.63, and 12.56, respectively.ConclusionIn terms of CEA, CUA, and MAUT, the method D was the highest in economic value, which usually can be used as a routine method for detecting CPE, but it needs a long procedure time; thus, the method E can be used for rapid detection when clinical severe infection occurred, which is superior in both cost-effectiveness and rapidity.
Objective To compare the bacterial spectrums of respiratory intensive care unit (RICU) patients derived from traditional bacterial culture and loop-mediated isothermal amplification (LAMP) assay. To analyze the relationship between clinical factors and clinical outcome of patients. Methods Data of patients in RICU with lower respiratory tract infection from October 2018 to December 2020 was collected. The bacterial spectrums obtained by traditional culture method and LAMP-based method were compared. Clinical factors were divided into two categories and taken into analysis of variance for assessing their relevance with clinical outcomes. Those with significances in analysis of variance were taken into binary logistic regression. Results A total of 117 patients were included. The ratio of patients with positive bacterial culture results was 39.13% (n=115), and that with positive LAMP assay results was 72.65% (n=117). The ratios of patients with at least two positive results for culture and LAMP were 8.70% (n=115) and 36.75% (n=117), respectively. According to chi-squared test, mechanical ventilation (χ2=5.260, P=0.022), and patients with two or more bacteria positive for LAMP assay (χ2=8.227, P=0.004) were related to higher risk of death. Mechanical ventilation and patients with two bacteria positive for LAMP assay were included in binary logistic regression. The odds ratio for death was 4.789 in patients with two or more bacteria positive by LAMP assay (95% confidence interval 1.198 - 19.144, P=0.027). Conclusions LAMP-based method is helpful in detecting more bacteria from respiratory tract specimens of RICU patients, which will be a contributor to precision medicine. Patients with at least two bacteria positive based on LAMP assay have higher risk of death.