Clinical and economic burden of community-onset multidrug-resistant infections requiring hospitalization.

OBJECTIVES: To analyze the clinical and economic burden of community-acquired (CA) or community-onset healthcare-associated (COHCA) multidrug-resistant (MDR) infections requiring hospitalization. METHODS: Case-control study. Adults admitted with CA or COHCA MDR infections were considered cases, while those admitted in the same period with non-MDR infections were controls. The matching criteria were source of infection and/or microorganism. Primary outcome was 30-day clinical failure. Secondary outcomes were 90-day and 1-year mortality, hospitalization costs and resource consumption. RESULTS: 194 patients (97 cases and 97 controls) were included. Multivariate analysis identified age (odds ratio [OR], 1.07, 95% confidence interval [CI], 1.01-1.14) and SOFA score (OR, 1.45, CI95%, 1.15-1.84) as independent predictors of 30-day clinical failure. Age (hazard ratio [HR] 1.09, 95%CI, 1.03-1.16) was the only factor associated with 90-day mortality, whereas age (HR 1.06, 95%CI, 1.03-1.09) and Charlson Index (HR 1.2, 95%CI, 1.07-1.34) were associated with 1-year mortality. MDR group showed longer hospitalization (p<0.001) and MDR hospitalization costs almost doubled those in the non-MDR group. MDR infections were associated with higher antimicrobial costs. CONCLUSIONS: Worse economic outcomes were identified with community-onset MDR infections. MDR was associated with worse clinical outcomes but mainly due to higher comorbidity of patients in MDR group, rather than multidrug resistance.

[Antimicrobial stewardship programme implementation in a medical ward]. / Implantación de un programa de optimización y uso racional de antimicrobianos en un modelo de área clínica médica.

OBJECTIVE: Antimicrobial stewardship programmes (ASP) have proven to be effective tools for reducing the use of antimicrobials. The purpose of the study is to evaluate the effect of an ASP implantation in a medical Ward. METHODS: Prospective intervention study in a medical ward with a heterogeneous composition. In September 2014, an ASP based on prospective audits was implemented. Antimicrobial consumption and the length of stay and mortality in all patients admitted, as well as in the main infections present in the unit, were compared before and after two years of the ASP implementation. RESULTS: A total of 378 infectious episodes of 335 pa-tients were evaluated in 168 meetings. The prescriber ac-cepted 92.3% of the suggestions. The consumption of an-timicrobials reviewed was reduced from 31.3 to 17.6 DDD / 100-stays (ß =-0.40, P = 0.015). The average cost per income was reduced from € 161.4 to € 123.3 (-23.6%). No differences were found in total length of stay or mortality. There were no changes in the incidence of Clostridium difficile infection or candidemia between the two periods. There were no significant differences in length of stay or mortality in total bacteremia, candidemia, and urinary tract infections caused by multiresistant bacteria. CONCLUSIONS: The implementation of an ASP in a heterogeneous medical ward significantly reduces the use of antimicrobials in a short time horizon without adversely affecting the evolution of the patients..

[Is a strategy of bio-socio-ethic necessary?]. / ¿Es necesaria una estrategia integrada de biosocioética?

AIM: The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors. METHOD: An observational cross-sectional descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention. RESULTS: 124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors. 75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently. CONCLUSIONS: The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used.

Clinical and economic impact of urinary tract infections caused by ESBL-producing Escherichia coli requiring hospitalization: A matched cohort study.

OBJECTIVE: To analyze the clinical and economic impact of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli requiring hospitalization. METHODS: Matched cohort study including adults with UTI caused by ESBL-producing E. coli admitted to a tertiary care hospital in Barcelona, Spain, between August 2010 and July 2013. Demographic, clinical and economic data were analyzed. RESULTS: One hundred and twenty episodes of UTI were studied: 60 due to ESBL-producing E. coli and 60 due to non-ESBL-producing E. coli. Bivariate analysis showed that prior antimicrobial treatment (p = 0.007) and ESBL production (p < 0.001) were related to clinical failure during the first 7 days. Multivariate analysis selected ESBL as the sole risk factor for clinical failure (p = 0.002). Regarding the economic impact of infections caused by ESBL-producing E. coli, an ESBL-producing infection cost more than a non-ESBL-producing E. coli infection (mean €4980 vs. €2612). Looking at hospital expenses separately, the total pharmacy costs and antibiotic costs of ESBL infections were considerably higher than for non-ESBL infections (p < 0.001), as was the need for outpatient parenteral antibiotic therapy (OPAT) and its related costs. Multivariate analysis performed for the higher costs of UTI episodes found statistically significant differences for males (p = 0.004), chronic renal failure (p = 0.025), ESBL production (p = 0.008) and OPAT (p = 0.009). CONCLUSION: UTIs caused by EBSL-producing E. coli requiring hospital admission are associated with worse clinical and economic outcomes.

An intercomparison of Monte Carlo codes used in gamma-ray spectrometry.

In an intercomparison exercise, the Monte Carlo codes most commonly used in gamma-ray spectrometry today were compared with each other in order to gauge the differences between them in terms of typical applications. No reference was made to experimental data; instead, the aim was to confront the codes with each other, as they were applied to the calculation of full-energy-peak and total efficiencies. Surprising differences between the results of different codes were revealed.

Lesiones hepáticas y esplénicas en el traumatismo de abdomen: aspectos epidemiológicos y manejo / Liver and spleen lesions in abdominal injury: epidemiology and management

Evaluar los aspectos epidemiológicos y el manejo de los traumatismos hepáticos y esplénicos. Es un estudio retrospectivo, de corte transversal, de los pacientes con laparotomía exploradora y diagnóstico de trauma hepático y/o trauma esplénico entre de 1998 a diciembre del 2002. Servicio de cirugía del Hospital General Dr. Luis Razetti, de Barinas Estado Barinas. Venezuela. En 121 pacientes hubo trauma hepático y en 50 esplénicos. Con predominio del sexo masculino y en el grupo etário de 21 a 40 años. El trauma abierto (78,21 por ciento) fue más frecuente en las lesiones hepáticas y el cerrado (64 por ciento) en las esplénicas. El 40,32 por ciento de los traumas cerrados ingresó en condiciones estables y de estos en el 68 por ciento la laparotomía fue no terapéutica. En el 63,63 por ciento de las lesiones hepáticas fue de grado I y II. La técnica quirúrgica fue la hepatorrafía. En el trauma esplénico el 60 por ciento de las lesiones fue grado IV y V; y se realizó esplectomía. La mortalidad por trauma hepático fue de 12,34 por ciento y la de trauma esplénico de 16 por ciento por las lesiones asociadas. El manejo del trauma hepático y esplénico fue realizado de forma conservadora, siendo la mayoría de las lesiones hepáticas leves. El manejo del trauma abdominal cerrado se basó en el diagnóstico clínico

[Identification of doctors with high pharmaceutical expenditure]. / Identificación de médicos con gasto farmacéutico elevado.

OBJECTIVE: [corrected] To identify doctors with high pharmaceutical expenditure through multiple regression of variables not exclusively dependent on the doctor's decision. To compare the agreement with the method of the Spanish national health servicem which only considered the percentage of pensioners of the doctor's list. METHODS: Cross-sectional, retrospective, descriptive study of the pharmaceutical expenditure of 220 general practitioners in the health district of Toledo (Spain) in 1999. The following variables were collected: pharmaceutical expenditure for policy-holder/month (PEP-H); age; sex; habitat; size of the list; percentage of pensioners; frequency of attendance (consults/policy-holder-year) and workload (consultations per day). A multiple regression model with backwards elimination was constructed, taking like PEP-H as the dependent variable and the remaining as the independent variables. The resultant equation enabled calculation of the expected PEP-H for each doctor and the deviation of their real expenditure ofrom the expected. Doctors were considered to have high pharmaceutical expenditure when the deviation was more than the mean plus 1 standard deviation of this distribution. RESULTS: The mean PEP-H was 2,584.4 pesetas. Differences were found (F = 11.665; p < 0.005) in PEP-H per habitat (2,723.2 in rural, 2,521.4 in semi urban and 2,168.2 in urban). A significant correlation was found (p < 0.005) between PEP-H and percentage of pensioners (r = 0.728) and frequency of attendance (r = 0.607). Our final model included percentage of pensioners, frequency of attendance, and age (F = 102.33; p < 0.005; r = 0.767; r² = 0.588; ß = 206.05; ß1 = 48.27; ß2 = 61.26; ß3 = 9.55). This model were identified 25 DHPC. With the INSALUD model the identification were of 31. The Kappa index showed that agreement between both methods was 0.706 (SE 0.056) and simple disagreement was found in the classification of 24 doctors (10.9%). CONCLUSIONS: Frequency of attendance and the percentage of pensioners on doctors' lists are iclosely related to PEP-H. The indicator currently used by the Spanish national health system to identify doctors with high pharmaceutical expenditure could be improved if other variables, such as frenquency of attendance and the doctors' age, were taken into account. The adoption of this method would make budget allocation more impartial and fair.

Economic study of neutropenia induced by myelotoxic chemotherapy.

This article describes the economic and social impact of neutropenia induced by myelotoxic chemotherapy in patients with cancer during the period 1 January-31 December 1991. Neutropenia is a life-threatening complication of chemotherapy in patients with cancer. The episodes of fever and infections originating from neutropenia require hospitalization of the patient until the granulocyte levels are restored. The calculation of the economic cost was based on the following parameters: length of stay in hospital, analytical tests performed on the patient, type and cost of drug therapy administered, blood transfusions performed, health assistance received, cost of isolation and absence from work. The overall economic cost of neutropenia in patients with cancer reached 329,775 pesetas ($2,893). Cost of the health-care staff was the largest budget item in relation to the total health resources estimated.