Measuring the economic costs of antimicrobial resistance in hospital settings: summary of the Centers for Disease Control and Prevention-Emory Workshop.

Health systems administrators and clinicians need refined calculations of the attributable cost of infections due to drug-resistant microorganisms to develop and assess cost-effective prevention strategies that deal with these infections. To date, however, efforts to provide this information have yielded widely variable and often conflicting estimates. This lack of reproducibility is largely attributable to problems in study design and in the methods used to identify and measure costs. Addressing these methodological issues was the focus of a workshop that included participants from a broad range of backgrounds, including economics, epidemiology, health care management, health care outcomes research, and clinical care. This workshop summary presents the advantages and disadvantages of various research designs as well as particular methodological issues related to the measurement of the economic cost of resistance in health care settings. Suggestions are made for needed common definitions and approaches, study areas for future research are considered, and priority investigations are identified.

Applying economic principles to health care.

Applying economic thinking to an understanding of resource use in patient care is challenging given the complexities of delivering health care in a hospital. Health-care markets lack the characteristics needed to determine a "market" price that reflects the economic value of resources used. However, resource allocation in a hospital can be analyzed by using production theory to determine efficient resource use. The information provided by hospital epidemiologists is critical to understanding health-care production processes used by a hospital and developing economic incentives to promote antibiotic effectiveness and infection control.

Long-term results of total joint arthroplasty in nonambulatory patients.

The authors conducted a long-term follow-up study of 27 patients, all confined to a bed or wheelchair for at least 6 months, who had total joint arthroplasty to relieve rest pain, correct deformity, and enable independent ambulation. The average duration of nonambulatory status before operation was 3 years (mean, 1 1/2 years), with the longest being 15 years. The patients required an average 3-month hospital stay and an average of three major total joint arthroplasties in the lower extremities. All of the patients were ambulatory at the time of discharge but required some sort of aid. After 1 year, 20 patients (74%) were able to launch independently; 9 (33%) could ambulate without aids; and 14 (52%) could ambulate with aids. At follow-up evaluation 3-12.8 years (average, 6.5 years) after operation, nine patients (33%) ambulated without aids, five (19%) required a single crutch or cane, and nine (33%) required bilateral crutches or a walker, for a total success rate of 85%, which did not deteriorate with time.

Bone scanning in the assessment of patellar viability following knee replacement.

In an attempt to diagnose avascular necrosis (AVN) of the patella, a potential complication of the surgical procedure, 99mTc-MDP bone scanning was performed pre- and postoperation in 37 patients treated by 41 total knee arthroplasties. The normal immediate postoperative scan should demonstrate increased radionuclide uptake in the patella when compared to preoperative scans. Decreased uptake was seen in four cases in the early postoperative period. This latter group was believed to be at risk for osteonecrosis and stress fracture of the patella. For this reason, prophylactic restriction of activity was instituted, with subsequent return of normal radionuclide uptake in the patella. Bone scanning provides an effective method of early diagnosis of patients at risk for the development of AVN and secondary patellar fractures following total knee arthroplasty.