Economic burden of recurrent Clostridioides difficile infection in adults admitted to Spanish hospitals. A multicentre retrospective observational study.

OBJECTIVE: Clostridioides difficile infection (CDI) is associated with increased hospital stays and mortality and a high likelihood of rehospitalization, leading to increased health resource use and costs. The objective was to estimate the economic burden of recurrent CDI (rCDI). METHODS: Observational, retrospective study carried out in six hospitals. Adults aged ≥18 years with ≥1 confirmed diagnosis (primary or secondary) of rCDI between January 2010 and May 2018 were included. rCDI-related resource use included days of hospital stay (emergency room, ward, isolation and ICU), tests and treatments. For patients with primary diagnosis of rCDI, the complete hospital stay was attributed to rCDI. When diagnosis of rCDI was secondary, hospital stay attributed to rCDI was estimated using 1:1 propensity score matching as the difference in hospital stay compared to controls. Controls were hospitalizations without CDI recorded in the Spanish National Hospital Discharge Database. The cost was calculated by multiplying the natural resource units by the unit cost. Costs (euros) were updated to 2019. RESULTS: We included 282 rCDI episodes (188 as primary diagnosis): 66.31% of patients were aged ≥65 years and 57.80% were female. The mean hospital stay (SD) was 17.18 (23.27) days: 86.17% of rCDI episodes were isolated for a mean (SD) of 10.30 (9.97) days. The total mean cost (95%-CI) per episode was €10,877 (9,499-12,777), of which the hospital stay accounted for 92.56. CONCLUSIONS: There is high cost and resource use associated with rCDI, highlighting the importance of preventing rCDI to the Spanish National Health System.

Prevalence of clinically significant antibodies in patients undergoing elective surgery in a Nigerian teaching hospital: A case for the type and screen method.

BACKGROUND: Provision of safe and adequate blood is challenging in our environment due to paucity of voluntary donors as well as inappropriate blood ordering and utilization. The type and screen (TS) method (typing of blood group and screening for antibodies) reduces the demand for blood reservation in hospital blood banks. AIMS: The aim of this study is to determine the safety (detection clinically significant antibodies) and cost effectiveness of the TS method compared to the conventional antiglobulin crossmatch (ACM). SETTINGS AND DESIGN AND METHODS: This was a cross-sectional prospective study carried out at the University of Port Harcourt Teaching Hospital (UPTH). 124 participants booked for elective surgeries with no history of blood transfusion or pregnancy were investigated. ACM was performed on all participants' serum against 159 donor red cells. TS was also performed blindly on the same participants' sera, antibody screening was done with three-screen-cells using the gel method. An 11-cell panel was used for antibody identification. Blood utilization was calculated using the crossmatch: transfusion ratio (CTR), probability of transfusion (%T) and transfusion index (TI). RESULTS: Out of the 159 units crossmatched for 124 study participants, only 19 were actually transfused (88.1% not utilized). The prevalence of compatible ACM was 100%, however the TS detected one antibody (0.81%) in a male participant identified as anti-M. The overall CTR, %T and TI were 8.4, 15.6% and 0.16 respectively, with N384,750 ($963.1) wastage in terms of cost. The TS method would have saved N266,000{$665.9} (N1900{4.78} per un-transfused patient). CONCLUSIONS: There was improper utilization of blood in elective surgeries. The TS method identified an antibody not detected by ACM. This would have saved N266,000 {$665.9}, and reduced the demand for blood reservation in the bank. Although The TS method was found not to be significantly different in outcome compared to the ACM, it was found to be cost effective.

Assessment of patient-reported outcome and quality of life improvement following surgery for epiphora.

PurposeTo assess and compare the subjective improvement in symptoms and quality of life in adult patients who underwent commonly performed oculoplastic surgical interventions to treat epiphora.Materials and methodsA prospective study was undertaken involving all adult patients undergoing dacryocystorhinostomy (DCR), lid tightening (lateral tarsal strip or lateral wedge resection), and punctoplasty surgery at our institution. We assessed severity of epiphora preoperatively using the Munk score. At 3 months postoperatively, all patients were sent postal questionnaires comprising of Munk score, 'social impact score' from validated Lac-Q questionnaire ranging from 0 (no impact) to 5 (maximal negative impact) and Glasgow Benefit Inventory (GBI) score, ranging from -100 (maximal detriment) to +100 (maximal benefit).ResultsA total of 134 questionnaires were sent with an overall response rate of 74.6%. For the purpose of data analysis, patients were divided into four groups: DCR, lid tightening, punctoplasty, and combined group (lid tightening plus punctoplasty). There was statistically significant improvement in subjective epiphora postoperatively, as assessed by Munk score (P<0.001) in all groups. The total GBI scores were +42.67 (95% CI: 33.42-51.91) for DCR, +19.65 (95% CI: 10.33-28.97) for lid tightening, +16.06 (95% CI: 2.65-29.48) for punctoplasty, and +26.53 (95% CI: 13.15-39.90) for the combined group, demonstrating a positive change in health status for all groups. There was negative correlation between total GBI and post-operative Munk scores (r=-0.58, P<0.001), and positive correlation between Lac-Q and Munk scores (r=0.65, P<0.001).ConclusionPatients derived significant improvement in symptoms and health-related quality of life benefit following all surgical interventions for epiphora.

The value of lacrimal scintillography in the assessment of patients with epiphora.

PurposeTo assess the influence of dacryoscintillography (DSG) on the treatment decision for patients with epiphora and clinically patent non-functioning lacrimal systems.MethodsA retrospective 3-year review. Inclusion: patients having DSG for epiphora with delayed tear clearance, lacrimal system patency on syringing, and no visible external cause for watering. On the basis of regurgitation during syringing, tear ducts were divided into freely patent (FP≤20%) or stenosed. The DSG results were examined for correlation with symptoms and clinical examination, the influence on decision to proceed to dacryocystorhinostomy (DCR), and the ability to predict the surgical outcome.ResultsA total of 242 eyes were examined. The clinical diagnosis was FP in 45.5%, nasolacrimal duct stenosis (NLDS) in 26.4%, and other in 3.3%. The DSG was normal in 30.9% of FP and 18.7% of NLDS eyes. Of the asymptomatic eyes, 46.7% had an abnormal DSG. DSG sensitivity was 73.6% and specificity 53.3%. There was no significant difference in DSG results in those with FP or NLDS.DCR was recommended in 39.1% of the symptomatic eyes with abnormal DSG. DCR surgery was considered inappropriate in all 46 eyes with normal DSG. DCR was successful in 76.5%, however, the DSG result did not affect the success of surgery.ConclusionDSG has severe limitations due to lack of correlation with symptoms and clinical examination, inability to separate lacrimal duct narrowing from lacrimal pump function, and inability to predict the results of surgery. DSG can at best provide limited guidance on whether to proceed to DCR surgery.