A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre¢s syndrome and peritonsillar abscesses

S. Bank*, K. Christensen, L. Hagelskjćr Kristensen, J. Prag

Author address: 

(Viborg, Aarhus, DK)

Abstract: 

Objectives: The main objective was to estimate the cost per quality adjusted life year (QALY) saved by identifying Fusobacterium necrophorum in throat swabs followed by proper antibiotic treatment, to reduce the incidence of Lemierre’s syndrome and peritonsillar abscesses (PTA) originating from a pharyngitis. The second objective was to estimate the population size required to indicate that antibiotic treatment has an effect. Methods: Data from publications and our laboratory were collected. Monte Carlo simulation and 1-way sensitivity analysis were used to analyse cost-effectiveness. Results: The cost-effectiveness analysis shows that examining throat swabs from 15 to 24 years old for F. necrophorum followed by antibiotic treatment probably will be less costly than most other life saving interventions, with a median cost of 8 795US $ per QALYsaved. To indicate a reduced incidence of Lemierre’s syndrome and peritonsillar abscess in Denmark, the intervention probably has to be followed for up to 5 years. Conclusion: Identifying F. necrophorum in throat swabs from 15 to 24 years old followed by proper antibiotic treatment only requires a reduction of 2025% in the incidence of Lemierre’s syndrome and PTA to be cost-effective. This study warrants further examination of the effect of antibiotic treatment on the outcome of F. necrophorum acute and recurrent pharyngitis as well as the effect on Lemierre’s syndrome and PTA.surfaces) in 11 rooms (with two to four beds each) and, three times a week, sputum from 70 patients suffering from haematological malignancies and admitted in the same rooms over the study period. Suspected IA cases are classified as proven, probable or possible according to the EORTC criteria. Results: We collected 1398 surfaces samples, of which, 1229 (87.9%) had a positive cultures with filamentous fungi. Of 439 air samples collected, 339 (90.9%) were positive. The most frequently isolated genus in all environmental samples was Aspergillus sp (21%), followed by Alternaria sp (16.4%), Penicillium sp (14.1%), Cladosporium sp (9.3%) and Rhizopus sp (7.8%). Aspergillus sp was isolated in 60.1% of air samples and in 52.6% of surfaces samples. Aspergillus niger was the most frequent species (52.4%), followed by A. flavus (27%), A. nidulans (5.4%) and A. fumigatus (2.9%). Of the 70 investigated patients, 19 were diagnosed with probable IA and 19 with possible IA. The overall estimated incidence of probable IA was 13%. Of 660 sputum collected from these 70 patients, Aspergillus sp species were isolated in 49 samples (7.4%): A. niger in 22 sputum (44.8%), A. flavus in 21 sputum (42.8%), A. nidulans in three sputum, and A. fumigatus in two sputum. Conclusion: Our findings showed that the mycological contamination of the Onco-Haematological Department of our hospital is high. This highlights the pertinence of the HEPA filters’ use in reducing the aspergillosis risk. In both, hospital environment and sputum samples, A. niger and A. flavus are the most common species. A. fumigatus seems rare in our region.
2012

abstract No: 

P773

Full conference title: 

22nd European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 22nd (2012)