Diagnostic stewardship to limit repeat plasma cytomegalovirus viral load testing.
Cytomegalovirus
Diagnostic stewardship
Molecular test
Monitoring
Viral load
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
09 Jun 2023
09 Jun 2023
Historique:
received:
08
12
2022
accepted:
27
05
2023
medline:
12
6
2023
pubmed:
10
6
2023
entrez:
9
6
2023
Statut:
epublish
Résumé
Frequent serial monitoring of plasma cytomegalovirus (CMV) viral load caused unnecessary budgets for laboratory testing without changes in treatment. We aimed to implement diagnostic stewardship to limit CMV viral load testing at appropriate intervals. A quasi-experimental study was performed. To avoid unnecessary plasma CMV viral load testing, the inpatient electronic pop-up reminder was launched in 2021. In cases with plasma CMV viral load testing was ordered in intervals of less than five days, telephone interview and feedback were performed. Pre-post intervention data was compared in terms of clinical and monetary outcomes. The rate of plasma CMV viral load testing performed in intervals of less than five days was compared between 2021 and 2019 using the Poisson regression model. After the protocol implementation, there was a significant decrease in the rate of plasma CMV viral load test orders in intervals of less than five days from 17.5% to 8.0% [incidence rate ratio 0.40, p < 0.001]. There was no statistically significant difference in the incidence of CMV DNAemia and CMV disease (p = 0.407 and 0.602, respectively). As a result, the hospital could save the costs of plasma CMV viral load testing per 1,000 patients performed with intervals of less than five days from 2,646,048.11 to 1,360,062.89 Thai Baht. The diagnostic stewardship program is safe and helpful in reducing unnecessary plasma CMV viral load testing and costs.
Sections du résumé
BACKGROUND
BACKGROUND
Frequent serial monitoring of plasma cytomegalovirus (CMV) viral load caused unnecessary budgets for laboratory testing without changes in treatment. We aimed to implement diagnostic stewardship to limit CMV viral load testing at appropriate intervals.
METHODS
METHODS
A quasi-experimental study was performed. To avoid unnecessary plasma CMV viral load testing, the inpatient electronic pop-up reminder was launched in 2021. In cases with plasma CMV viral load testing was ordered in intervals of less than five days, telephone interview and feedback were performed. Pre-post intervention data was compared in terms of clinical and monetary outcomes. The rate of plasma CMV viral load testing performed in intervals of less than five days was compared between 2021 and 2019 using the Poisson regression model.
RESULTS
RESULTS
After the protocol implementation, there was a significant decrease in the rate of plasma CMV viral load test orders in intervals of less than five days from 17.5% to 8.0% [incidence rate ratio 0.40, p < 0.001]. There was no statistically significant difference in the incidence of CMV DNAemia and CMV disease (p = 0.407 and 0.602, respectively). As a result, the hospital could save the costs of plasma CMV viral load testing per 1,000 patients performed with intervals of less than five days from 2,646,048.11 to 1,360,062.89 Thai Baht.
CONCLUSIONS
CONCLUSIONS
The diagnostic stewardship program is safe and helpful in reducing unnecessary plasma CMV viral load testing and costs.
Identifiants
pubmed: 37296377
doi: 10.1186/s12879-023-08355-0
pii: 10.1186/s12879-023-08355-0
pmc: PMC10251324
doi:
Substances chimiques
DNA, Viral
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
387Informations de copyright
© 2023. The Author(s).
Références
Leuk Lymphoma. 2020 Aug;61(8):1996-2002
pubmed: 32281491
Transpl Infect Dis. 2021 Aug;23(4):e13586
pubmed: 33595158
Rheumatol Int. 2019 Jul;39(7):1229-1240
pubmed: 31076831
Crit Care. 2009;13(3):R68
pubmed: 19442306
Biol Blood Marrow Transplant. 2018 Oct;24(10):2094-2100
pubmed: 29753836
Infect Control Hosp Epidemiol. 2020 Apr;41(4):411-417
pubmed: 32036798
Transpl Infect Dis. 2021 Feb;23(1):e13455
pubmed: 32881220
Respirol Case Rep. 2021 Jun 08;9(7):e00801
pubmed: 34136262
Clin Infect Dis. 2016 Sep 1;63(5):583-9
pubmed: 27307504
Open Forum Infect Dis. 2020 Aug 21;7(10):ofaa366
pubmed: 33094113
J Infect Chemother. 2003 Sep;9(3):265-7
pubmed: 14513398
Clin Infect Dis. 2018 Feb 1;66(4):617-631
pubmed: 29020339
Blood. 2016 May 19;127(20):2427-38
pubmed: 26884374
Blood Rev. 2017 May;31(3):173-183
pubmed: 28173959
IDCases. 2021;24:e01111
pubmed: 33842207
Infect Dis Ther. 2018 Mar;7(1):1-16
pubmed: 29204910
Ther Adv Infect Dis. 2020 Sep 22;7:2049936120959561
pubmed: 33014363
Clin Infect Dis. 2002 Apr 15;34(8):1094-7
pubmed: 11914998
Am J Transplant. 2006 Feb;6(2):262-74
pubmed: 16426310
Ann Transplant. 2019 May 28;24:304-311
pubmed: 31133632
Adv Rheumatol. 2019 Mar 18;59(1):12
pubmed: 30885265
J Virol Methods. 2015 Dec 1;225:1-3
pubmed: 26341060
Clin Microbiol Infect. 2014 Sep;20 Suppl 7:19-26
pubmed: 26451404
Lancet Infect Dis. 2019 Aug;19(8):e260-e272
pubmed: 31153807
Pan Afr Med J. 2020 Jul 09;36:167
pubmed: 32952811
J Infect Chemother. 2016 Aug;22(8):505-14
pubmed: 27344206
Clin Infect Dis. 2012 Jun;54(12):1793-7
pubmed: 22412060
Trop Med Infect Dis. 2021 Feb 10;6(1):
pubmed: 33579042
Int J Hematol. 2010 Jun;91(5):877-85
pubmed: 20490728
Blood. 2011 Nov 17;118(20):5689-96
pubmed: 21937692
Transplantation. 2018 Jun;102(6):900-931
pubmed: 29596116
Infect Control Hosp Epidemiol. 2021 Jan;42(1):51-56
pubmed: 32943129
Anticancer Res. 2017 Dec;37(12):6551-6556
pubmed: 29187429
Transplant Proc. 2011 Jul-Aug;43(6):2145-8
pubmed: 21839217
J Clin Microbiol. 2020 Aug 24;58(9):
pubmed: 32493787
Front Med (Lausanne). 2020 May 15;7:188
pubmed: 32500076