RESUMO
BACKGROUND: Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID. METHODS: We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks. RESULTS: The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72-0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95-0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87-0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97-0.99) for non-purulent SSTVI. CONCLUSIONS: Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.
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Análise Custo-Benefício , Programas de Troca de Agulhas , Anos de Vida Ajustados por Qualidade de Vida , Infecções dos Tecidos Moles , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Programas de Troca de Agulhas/economia , Doenças Vasculares/economia , Dermatopatias Infecciosas/prevenção & controle , Canadá/epidemiologia , Simulação por Computador , Redução do Dano , Feminino , Masculino , Adulto , Modelos EconômicosRESUMO
INTRODUCTION: Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery. METHODS: The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs. RESULTS: Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget. CONCLUSION: Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.
Assuntos
Serviços de Saúde do Indígena , Aceitação pelo Paciente de Cuidados de Saúde , Dermatopatias Infecciosas , Infecções dos Tecidos Moles , Humanos , Austrália/epidemiologia , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Atenção à Saúde , Estudos Retrospectivos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
Cellulitis is a common skin infection resulting in increasing hospitalizations and health care costs. There is no gold standard diagnostic test, making cellulitis a potentially challenging condition to distinguish from other mimickers. Physical examination typically demonstrates poorly demarcated unilateral erythema with warmth and tenderness. Thorough history and clinical examination can narrow the differential diagnosis of cellulitis and minimize unnecessary hospitalization. Antibiotic selection is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit.
Assuntos
Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Dermatopatias Infecciosas/patologia , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Celulite (Flegmão)/fisiopatologia , Diagnóstico Diferencial , Progressão da Doença , Eritema/patologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Exame Físico/métodos , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Dermatopatias Infecciosas/microbiologiaAssuntos
COVID-19 , Dermatologia/métodos , Fotografação , Encaminhamento e Consulta , Dermatopatias/diagnóstico , Dermatopatias/terapia , Telemedicina/métodos , Triagem/métodos , Acne Vulgar/diagnóstico , Acne Vulgar/terapia , Alopecia/diagnóstico , Alopecia/terapia , Atenção à Saúde , Dermatologia/organização & administração , Eczema/diagnóstico , Eczema/terapia , Humanos , Intertrigo/diagnóstico , Intertrigo/terapia , Atenção Primária à Saúde , Psoríase/diagnóstico , Psoríase/terapia , SARS-CoV-2 , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Telemedicina/organização & administração , Telefone , Reino Unido , Urticária/diagnóstico , Urticária/terapiaRESUMO
OBJECTIVES: 1) To measure frequency and yield of blood cultures obtained for observation status adult patients with skin and soft tissue infection (SSTI), 2) describe how often blood cultures were performed according to Infectious Diseases Society of America (IDSA) SSTI guideline indications, 3) identify proportion of patients meeting Center for Medicare Services (CMS) sepsis criteria. DESIGN: Retrospective cohort. SETTING: Tertiary academic center. PATIENTS: Consecutive adult observation status patients hospitalized with SSTI between July 2017 and July 2018. METHODS: We measured the proportion and results of blood cultures obtained among the study cohort and proportion of obtained cultures that satisfied IDSA indications. RESULTS: We identified 132 observation status patients with SSTI during the study period; 67 (50.8%) had blood cultures drawn. Only 14 (10.6%) patients met IDSA indications for culture; 51 (38.%) met Center for Medicare Services definition for sepsis. We identified two (3.0%) cases of bacteremia and two (3.0%) cases of skin bacteria contamination. In multivariable analysis, only temperature > 38 °C (OR 3.84, 95%CI 1.09-13.60) and white race (OR 2.71, 95%CI 1.21-6.20) were associated with blood culture obtainment; neither meeting IDSA SSTI guideline indications nor meeting CMS sepsis criteria was associated with culture. CONCLUSIONS: Among observation status patients with SSTI, over half had blood cultures drawn, though 10% satisfied guideline indications for culture. The proportion of cultures with bacterial growth was low and yielded as many skin contaminants as cases of bacteremia. Our study highlights the need for further quality improvement efforts to reduce unnecessary blood cultures in routine SSTI cases.
Assuntos
Hemocultura , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Estados UnidosRESUMO
The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations.
Assuntos
Atenção à Saúde , Dermatologia/métodos , Helmintíase/terapia , Doenças Negligenciadas/terapia , Dermatopatias Infecciosas/terapia , Medicina Tropical/métodos , Dermatologia/educação , Dermatologia/organização & administração , Gerenciamento Clínico , Elefantíase/diagnóstico , Elefantíase/terapia , Filariose Linfática/diagnóstico , Filariose Linfática/terapia , Helmintíase/diagnóstico , Helmintíase/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/terapia , Doenças Negligenciadas/diagnóstico , Esquistossomose/diagnóstico , Esquistossomose/terapia , Dermatopatias/diagnóstico , Dermatopatias/fisiopatologia , Dermatopatias/terapia , Dermatopatias Infecciosas/diagnóstico , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/terapia , Medicina Tropical/educação , Medicina Tropical/organização & administraçãoRESUMO
OBJECTIVES: In preparation for the future arrival of a group A Streptococcus (GAS) vaccine, this study estimated the economic and health burdens of GAS diseases in New Zealand (NZ). METHODS: The annual incidence of GAS diseases was based on extrapolation of the average number of primary healthcare episodes managed each year in general practices (2014-2016) and on the average number of hospitalizations occurring each year (2005-2014). Disease incidence was multiplied by the average cost of diagnosing and managing an episode of disease at each level of care to estimate the annual economic burden. RESULTS: GAS affected 1.5% of the population each year, resulting in an economic burden of 29.2 million NZ dollars (2015 prices) and inflicting a health burden of 2373 disability-adjusted life years (DALYs). Children <5 years of age were the most likely age group to present for GAS-related healthcare. Presentations for superficial throat and skin infections (predominantly pharyngitis and impetigo) were more common than other GAS diseases. Cellulitis contributed the most to the total economic and health burdens. Invasive and immune-mediated diseases disproportionately contributed to the total economic and health burdens relative to their frequency of occurrence. CONCLUSION: Preventing GAS diseases would have substantial economic and health benefits in NZ and globally.
Assuntos
Celulite (Flegmão)/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/economia , Celulite (Flegmão)/microbiologia , Criança , Pré-Escolar , Feminino , Hospitalização/economia , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/economia , Dermatopatias Infecciosas/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/economia , Infecções Estreptocócicas/microbiologia , Adulto JovemRESUMO
OBJECTIVES: Return visits to the emergency department (ED) and subsequent readmissions are common for patients who are unable to fill their prescriptions. We sought to determine if dispensing medications to patients in an ED was a cost-effective way to decrease return ED visits and hospital admissions for skin and soft tissue infections (SSTIs). METHODS: A retrospective review of ED visits for SSTIs, during the 24 weeks before and after the implementation of a medication dispensing program, was conducted. Charts were analyzed for both ED return visits and hospital admissions within 7 days and 30 days of the initial ED visit. Return visits were further reviewed to determine if the clinical conditions on subsequent visits were related to the initial ED presentation. A cost analysis comparing the cost of treatment to cost savings for return visits was also performed. RESULTS: Before the implementation of the medication dispensing program, the return rate in 7 days for the same condition was 9.1% and the rate of admission was 2.8%. The return rate for the same condition in 8-30 days was 2.1% and the rate of admission was 1.0%. After the implementation of the medication dispensing program, the return rate for the same condition in 7 days was 8.0%, and the admission rate was 1.7%. The return rate for the same condition in 8-30 days was 0.8%, and the admission rate was 0%. The total cost of dispensed medications was $4050, while total cost savings were estimated to be $95,477. CONCLUSION: A medication dispensing program in the ED led to a reduction in return visits and admissions for SSTIs at both 7 days and 30 days. For a cost of only $4050, an estimated total of $95,477 was saved. A medication dispensing program is a cost-effective way to reduce return visits to the ED and subsequent admissions for certain conditions.
Assuntos
Antibacterianos/uso terapêutico , Atenção à Saúde/métodos , Serviço Hospitalar de Emergência , Hospitalização/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Assistência Farmacêutica , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Abscesso/tratamento farmacológico , Celulite (Flegmão)/tratamento farmacológico , Cefalexina/uso terapêutico , Clindamicina/uso terapêutico , Redução de Custos , Análise Custo-Benefício , Custos e Análise de Custo , Doxiciclina/uso terapêutico , Custos de Medicamentos , Gastos em Saúde , Acessibilidade aos Serviços de Saúde , Hospitalização/economia , Humanos , Sistemas de Medicação no Hospital , Readmissão do Paciente/economia , Projetos Piloto , Meios de Transporte , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
BACKGROUND: Despite concerns about the burden of the bacterial and fungal infection syndromes related to injection drug use (IDU), robust estimates of the public health burden of these conditions are lacking. The current article reviews and compares data sources and national burden estimates for infective endocarditis (IE) and skin and soft-tissue infections related to IDU in the United States. METHODS: A literature review was conducted for estimates of skin and soft-tissue infection and endocarditis disease burden with related IDU or substance use disorder terms since 2011. A range of the burden is presented, based on different methods of obtaining national projections from available data sources or published data. RESULTS: Estimates using available data suggest the number of hospital admissions for IE related to IDU ranged from 2900 admissions in 2013 to more than 20 000 in 2017. The only source of data available to estimate the annual number of hospitalizations and emergency department visits for skin and soft-tissue infections related to IDU yielded a crude estimate of 98 000 such visits. Including people who are not hospitalized, a crude calculation suggests that 155 000-540 000 skin infections related to IDU occur annually. DISCUSSION: These estimates carry significant limitations. However, regardless of the source or method, the burden of disease appears substantial, with estimates of thousands of episodes of IE among persons with IDU and at least 100 000 persons who inject drugs (PWID) with skin and soft-tissue infections annually in the United States. Given the importance of these types of infections, more robust and reliable estimates are needed to better quantitate the occurrence and understand the impact of interventions.
Assuntos
Efeitos Psicossociais da Doença , Endocardite Bacteriana/mortalidade , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Usuários de Drogas/estatística & dados numéricos , Endocardite Bacteriana/etiologia , Humanos , Dermatopatias Infecciosas/etiologia , Infecções dos Tecidos Moles/etiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection. METHOD: We used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team. RESULTS: Six publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff. CONCLUSIONS: This study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice.
Assuntos
Tomada de Decisão Clínica , Medicina Baseada em Evidências , Instituição de Longa Permanência para Idosos , Infecções/diagnóstico , Infecções/tratamento farmacológico , Guias de Prática Clínica como Assunto , Idoso , Humanos , Casas de Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/tratamento farmacológico , Reino Unido , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológicoRESUMO
BACKGROUND: Previous studies showed a large inpatient burden of psoriasis in the United States. Less is known about the hospital readmission for psoriasis. OBJECTIVES: To determine the patterns and predictors of hospital readmission rates for psoriasis. METHODS: We analyzed data from the 2012-2014 Nationwide Readmissions Database, a representative sample of hospital readmissions in the United States. RESULTS: Among 2606 admissions for psoriasis, 216 had ≥1 readmissions for psoriasis (prevalence [95% confidence interval]: 8.3% [6.6%-10.0%]) and 918 for all-causes (35.2% [32.2%-38.3%]). The mean annual cost of first readmission for any reason was $3,500,141, with $8,357,961 for subsequent readmissions. In multivariable regression models, readmission for psoriasis was associated with ≥6 day-long index hospitalization (adjusted hazard ratio [95% confidence interval]: 1.82 [1.06-3.12]), teaching hospital (1.93 [1.13-3.31]), comorbid skin infection (2.13 [1.11-4.08]), and hospitalization in the autumn (4.51 [2.54-8.00]), but inversely associated with other infections (0.49 [0.26-0.92]). Readmissions for psoriasis increased from 2012 to 2014 (1.93 [1.26-2.93]). LIMITATIONS: No data on psoriasis characteristics. CONCLUSION: Inpatients with psoriasis had high rates of readmission overall but low rates of readmission for psoriasis per se. A subset of psoriasis patients was hospitalized repeatedly and responsible for most inpatients costs. Future interventions are needed to lower readmission rates among psoriasis patients.
Assuntos
Efeitos Psicossociais da Doença , Readmissão do Paciente/tendências , Psoríase/economia , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Previsões , Custos Hospitalares/estatística & dados numéricos , Custos Hospitalares/tendências , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Psoríase/epidemiologia , Psoríase/imunologia , Psoríase/terapia , Fatores de Risco , Dermatopatias Infecciosas/economia , Dermatopatias Infecciosas/imunologia , Dermatopatias Infecciosas/terapia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally.
Assuntos
População Rural/estatística & dados numéricos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Eczema/diagnóstico , Eczema/terapia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estado Independente de Samoa , Masculino , Pobreza/estatística & dados numéricos , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Tinha Versicolor/diagnóstico , Tinha Versicolor/terapiaRESUMO
OBJECTIVE: To identify the prevalent skin disorders among primary school children, awareness of its risk factors and to assess the socio-demographic determinants associated with their development. METHODS: The cross-sectional observational study was conducted in September-December 2016 comprising children from six public and private schools in Wadi Al Dawaser region of Eastern Saudi Arabia. A self-generated self-administered questionnaire was sent through the children to be filled up by their parents. Details on sociodemographic and skin dermatoses conditions were collected. Data were analyzed using SPSS 16.. RESULTS: Of the 710 students approached, 499(70.2%) responded. Of them, 151(30.2%) were boys and 348(69.7%) were girls. The overall mean age was 10.3}1.4 years (range: 3-15 years). The overall prevalence of skin disorders was 118(23.6%). Allergic dermatoses 11(11.3%) and eczema 4(11.8%) were the commonest conditions. Lichen planus 6(5%), acne 9(7.6%), allergic rashes 4(3.3%), and psoriasis 3(2.5%) were also recorded. Sociodemographic and hygiene factors were significantly associated with the disease (p<0.05 each). CONCLUSIONS: A high prevalence of skin disorders was encountered among primary school children in the region studied.
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Dermatopatias/epidemiologia , Acne Vulgar/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Estudos Transversais , Dermatite Alérgica de Contato/epidemiologia , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Feminino , Humanos , Líquen Plano/epidemiologia , Masculino , Animais de Estimação , Prevalência , Arábia Saudita/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Fatores Socioeconômicos , Vitiligo/epidemiologiaRESUMO
BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) is a chronic, inflammatory disease affecting both children and adults. AD is associated with multiple comorbidities and complications. In particular, AD patients are susceptible to developing cutaneous infections. Studies show that comorbidities have contributed significantly to increased health care utilization and costs in AD. However, evidence regarding the degree to which this increased health care utilization and expenditure in AD is attributable to cutaneous infections is lacking. The aim of this study was to assess the impact of skin infections on health care utilization and expenditures among patients with atopic dermatitis. METHODS: This cross-sectional study examined health care utilization and expenditures for AD patients of all ages with and without skin infections in the United States using the nationally representative 1996-2015 Medical Expenditure Panel Survey (MEPS) data. RESULTS: In this study, a total of 4 825 668 (weighted) patients had a diagnosis of AD (mean age 5.7). Of these, 776 753 patients (16%) experienced skin infections (mean age 4.4). Compared to AD patients without skin infections, those with skin infections had more frequent visits to ambulatory clinics (P = 0.001) and the emergency department (P = 0.011), and increased hospitalization (P = 0.010), after adjustments for demographic and clinical factors. AD patients with skin infections were also given 3.3 more prescriptions (P < 0.0001). AD patients with skin infections incurred significantly greater health care costs, which included an additional $351/patient/year for ambulatory visits (P < 0.0001) and an additional $177/patient/year for prescription medications (P < 0.0001). CONCLUSIONS: Atopic dermatitis patients with cutaneous infections incurred significantly greater health care utilization and expenditures than those without cutaneous infections.
Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/economia , Dermatite Atópica/microbiologia , Custos de Cuidados de Saúde , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/economia , Adolescente , Adulto , Assistência Ambulatorial/economia , Criança , Pré-Escolar , Estudos Transversais , Dermatite Atópica/terapia , Serviço Hospitalar de Emergência/economia , Feminino , Gastos em Saúde , Hospitalização/economia , Humanos , Masculino , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/uso terapêutico , Dermatopatias Infecciosas/terapia , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation. OBJECTIVE: To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation. METHODS: We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation. RESULTS: There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points. LIMITATIONS: Single-center design may reduce generalizability. CONCLUSION: At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings.
Assuntos
Celulite (Flegmão)/diagnóstico , Redução de Custos , Técnicas de Apoio para a Decisão , Erros de Diagnóstico/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Celulite (Flegmão)/terapia , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Custos Hospitalares , Hospitais Urbanos , Humanos , Tempo de Internação/economia , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Fatores de TempoRESUMO
OBJECTIVE: The aim of this study was to compare the incidence of skin and soft tissue infections (SSTIs) across healthcare settings and analyze direct healthcare expenditures related to SSTIs in 2000 and 2012 in the United States. METHODS: We performed a retrospective, cross-sectional analysis of nationally representative data from the Medical Expenditure Panel Surveys. Population-based incidence rates were examined for all healthcare settings that include inpatient visits, emergency department visits and ambulatory visits for SSTIs. The direct costs of healthcare services utilization were reported. Population-based prescribing rates for each antimicrobial class during ambulatory visits were compared. RESULTS: A total of 2.4 million patients experienced an SSTI in 2000 compared to 3.3 million in 2012 (40% increase). From 2000 to 2012, the incidence of patients with at least one hospital visit for SSTIs increased 22%, ambulatory care visits increased 30%, and emergency department visits increased 40%. The incidence of SSTIs in children and adolescents declined 50% (from 150 to 76 per 10,000 person; RR = 0.51, 95% CI: 0.38-0.67; p<0.001) whereas SSTIs in older adults (> 65 years of age) increased almost 2-fold (from 67 to 130 per 10,000 person; RR = 1.94, 95% CI: 1.44-2.61; p<0.001). The annual incidence of SSTI in adults did not change significantly from 2000 to 2012 (from 84 to 81 per 10,000 person; RR = 0.96, 95% CI: 0.71-1.31; p = 0.41). The total estimated direct healthcare costs of SSTIs increased 3-fold from $4.8 billion in 2000 to $15.0 billion in 2012, largely driven by an 8-fold increase in ambulatory expenditures for SSTIs. Total population-based antimicrobial prescription rates for SSTIs increased 4-fold from 2000 to 2012 (from 59.5 to 250.4 per 10,000 person). CONCLUSIONS: The highest healthcare utilization for SSTI treatment occurred in the ambulatory care setting and also accounted for the largest increase in overall direct expenditures from 2000 to 2012.
Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/tendências , Antibacterianos/uso terapêutico , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias Infecciosas/economia , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/economia , Infecções dos Tecidos Moles/terapia , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Enterococcus faecalis/efeitos dos fármacos , Fluoroquinolonas , Pseudomonas aeruginosa/efeitos dos fármacos , Dermatopatias Infecciosas , Staphylococcus aureus/efeitos dos fármacos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/economia , Custos e Análise de Custo , Enterococcus faecalis/isolamento & purificação , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/efeitos adversos , Fluoroquinolonas/economia , Humanos , Pseudomonas aeruginosa/isolamento & purificação , Índice de Gravidade de Doença , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/microbiologia , Staphylococcus aureus/isolamento & purificação , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: Vancomycin is the most prescribed antibiotic for hospitalized adults with skin and skin structure infections. Vancomycin is associated with acute kidney injury. Iclaprim is an antibiotic under development for the treatment of patients with acute bacterial skin and skin structure infections and is not associated with acute kidney injury. This economic model sought to determine the potential cost saving with iclaprim owing to avoidance of vancomycin-associated acute kidney injury among hospitalized patients with acute bacterial skin and skin structure infections. MATERIALS AND METHODS: A hospital cost-minimization model was developed to estimate the overall cost impact of replacing empiric vancomycin with iclaprim among hospitalized adult patients with skin and skin structure infections. The structural model included: vancomycin acquisition; vancomycin assay; incidence of vancomycin-associated acute kidney injury; excess hospital length of stay if acute kidney injury occurred; frequency/cost of specialty physician consults after occurrence of acute kidney injury; and probability/cost of acute dialysis as a result of acute kidney injury. Iclaprim treatment duration was 7 days and iclaprim acquisition cost was varied to determine the upper end of the daily iclaprim price that still conferred cost savings relative to vancomycin. Duration of hospitalization for iclaprim was assumed to be the same as patients with no acute kidney injury. RESULTS: Based on the overall acute kidney injury rate (9.2%), the neutral acquisition price threshold for iclaprim vs. vancomycin was US$1373.47/regimen. Across various subpopulations where acute kidney injury risk ranged between 9.2 and 16.7%, the daily iclaprim acquisition cost that still conferred cost savings was up to US$300/day. CONCLUSIONS: Iclaprim has the potential to reduce the economic burden of acute bacterial skin and skin structure infections in hospitalized patients at risk for vancomycin-associated acute kidney injury when iclaprim acquisition is US$300/day or less.
Assuntos
Injúria Renal Aguda/economia , Redução de Custos/métodos , Hospitalização/economia , Pirimidinas/economia , Dermatopatias Infecciosas/economia , Vancomicina/economia , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/prevenção & controle , Antibacterianos/efeitos adversos , Antibacterianos/economia , Antagonistas do Ácido Fólico/efeitos adversos , Antagonistas do Ácido Fólico/economia , Humanos , Pirimidinas/uso terapêutico , Dermatopatias Infecciosas/tratamento farmacológico , Vancomicina/efeitos adversosRESUMO
BACKGROUND: People with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control. Our aim was to estimate the association between diabetes and infections occurring in primary care. METHODS: Using the Newfoundland and Labrador Sentinel of the Canadian Primary Care Sentinel Surveillance Network, patients with diabetes ≥18 years between 1 January 2008 and 31 March 2013 were included with at least 1-year of follow-up. We randomly matched each patient with diabetes on the date of study entry with up to 8 controls without diabetes. Primary outcome was the occurrence of ≥1 primary care physician visits for any infectious disease. Secondary outcomes included primary visits for head & neck, respiratory, gastrointestinal, genitourinary, skin and soft tissue, musculoskeletal, and viral infections. Using multivariable conditional logistic regression analysis, we measured the independent association between diabetes and the occurrence of infections. RESULTS: We identified 1779 patients with diabetes who were matched to 11,066 patients without diabetes. Patients with diabetes were older, had a higher prevalence of comorbidities, and were more often referred to specialists. After adjusting for potential confounders, patients with diabetes had an increased risk of any infection compared to patients without diabetes (adjusted odds ratio = 1.21, 95% confidence interval 1.07-1.37). Skin and soft tissue infections had the strongest association, followed by genitourinary, gastrointestinal, and respiratory infections. Diabetes was not associated with head and neck, musculoskeletal, or viral infections. CONCLUSION: Patients with diabetes appear to have an increased risk of certain infections compared to patients without diabetes.
Assuntos
Diabetes Mellitus/patologia , Infecções/complicações , Adulto , Idoso , Canadá/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Humanos , Infecções/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Atenção Primária à Saúde , Risco , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/epidemiologiaRESUMO
PURPOSE OF REVIEW: To summarize the current finding on SSTIs/ABSSSIs treatment duration. RECENT FINDINGS: In 2013, the FDA approved the definition of acute bacterial skin and skin structure infections (ABSSSIs). From a clinical point of view, the new definition may present some advantages: the definition of the severity of the disease, the measurement of reduction in lesion size, and effectiveness of treatment primary endpoint at 48-72âh after treatment initiation. New therapeutic options with improved efficacy, safety, and/or pharmacodynamics are available for ABSSSIs and so far, several questions still need to be addressed for the management of these infections, including treatment duration. SUMMARY: There is a wide variation of duration of antimicrobial treatment in skin and soft tissue infections. Plenty of published data available suggest that we should focus on the early response to shorten duration of treatment, and that the antimicrobial stewardship perspective is extremely helpful in underscoring the need for composite outcomes in clinical practice, as multiple tools are available to increase cost-efficacy, including reduction of treatment changes, early oral switch, early discharge (even from the Emergency Department), outpatient antimicrobial treatment, long-acting antibiotics, and all together, de-escalation treatment strategies.