RESUMEN
OBJECTIVES: Optimising blood culture processing is important to ensure that bloodstream infections are accurately diagnosed while minimising adverse events caused by antibiotic abuse. This study aimed to evaluate the impact of optimised blood culture processes on antibiotic use, clinical outcomes and economics in intensive care unit (ICU) patients with positive blood cultures. METHODS: From March 2020 to October 2021, this microbiology laboratory implemented a series of improvement measures, including the clinical utility of Fastidious Antimicrobial Neutralization (FAN® PLUS) bottles for the BacT/Alert Virtuo blood culture system, optimisation of bottle reception, graded reports and an upgraded laboratory information system. A total of 122 ICU patients were included in the pre-optimisation group from March 2019 to February 2020, while 179 ICU patients were included in the post-optimisation group from November 2021 to October 2022. RESULTS: Compared with the pre-optimisation group, the average reporting time of identification and antimicrobial sensitivity was reduced by 16.72 hours in the optimised group. The time from admission to targeted antibiotic therapy within 24 hours after receiving both the Gram stain report and the final report were both significantly less in the post-optimisation group compared with the pre-optimisation group. The average hospitalisation time was reduced by 6.49 days, the average antimicrobial drug cost lowered by $1720.85 and the average hospitalisation cost by $9514.17 in the post-optimisation group. CONCLUSIONS: Optimising blood culture processing was associated with a significantly increased positive detection rate, a remarkable reduction in the length of hospital stay and in hospital costs for ICU patients with bloodstream infections.
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Antibacterianos , Cultivo de Sangre , Enfermedad Crítica , Unidades de Cuidados Intensivos , Humanos , Cultivo de Sangre/métodos , Cultivo de Sangre/economía , Masculino , Femenino , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Antibacterianos/economía , Anciano , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/economía , Bacteriemia/microbiología , Adulto , Tiempo de Internación , Pruebas de Sensibilidad Microbiana/economía , Pruebas de Sensibilidad Microbiana/métodosRESUMEN
OBJECTIVES: Vancomycin-resistant enterococcus infections impact mortality in oncology patients. Given the low rate of vancomycin-resistant enterococcus bacteremia, low virulence of vancomycin-resistant enterococcus, and advent of rapid diagnostic systems, vancomycin-resistant enterococcus-directed empiric therapy in vancomycin-resistant enterococcus-colonized patients with neutropenic fever may be unnecessary, promoting increased antimicrobial resistance, drug-related toxicity, and cost. METHODS: Vancomycin-resistant enterococcus-colonized adults admitted for hematopoietic stem cell transplantation or induction therapy for acute leukemia/myeloid sarcoma with neutropenic fever were stratified by vancomycin-resistant enterococcus bacteremia development and empiric vancomycin-resistant enterococcus-directed antimicrobial strategy for first neutropenic fever (Empiric Therapy vs. non-Empiric Therapy). Primary endpoints included vancomycin-resistant enterococcus-related, in-hospital, and 100-day mortality rates. Secondary outcomes included vancomycin-resistant enterococcus bacteremia incidence for first neutropenic fever and the entire hospitalization, length of stay, Clostridioides difficile infection rate, and duration and cost of vancomycin-resistant enterococcus-directed therapy. RESULTS: During first neutropenic fever, 3 of 70 eligible patients (4%) developed vancomycin-resistant enterococcus bacteremia. Although all 3 (100%) were non-Empiric Therapy, no mortality (0%) occurred. Of 67 patients not developing vancomycin-resistant enterococcus bacteremia, 42 (63%) received Empiric Therapy and 25 (37%) non-Empiric Therapy. Empiric Therapy had significantly greater median duration (3 days vs. 0 days; P<.001) and cost ($1604 vs. $0; P<.001) of vancomycin-resistant enterococcus-directed therapy but demonstrated no significant differences in clinical outcomes. CONCLUSION: Available data suggest Empiric Therapy may offer no clinical benefit to this population, regardless of whether vancomycin-resistant enterococcus is identified in blood culture or no pathogen is found. Such an approach may only expose the majority of patients to unnecessary vancomycin-resistant enterococcus-directed therapy and drug-related toxicities while increasing institutional drug and monitoring costs. Even in the few patients developing vancomycin-resistant enterococcus bacteremia, waiting until the organism is identified in culture to start directed therapy likely makes no difference in mortality. This lack of benefit warrants consideration to potentially omit empiric vancomycin-resistant enterococcus-directed therapy in first neutropenic fever in many of these patients.
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Antibacterianos/uso terapéutico , Neutropenia Febril/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/etiología , Resistencia a la Vancomicina , Adulto , Anciano , Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Bacteriemia/tratamiento farmacológico , Bacteriemia/economía , Bacteriemia/epidemiología , Bacteriemia/etiología , Índice de Masa Corporal , Infecciones por Clostridium/epidemiología , Enterococcus , Femenino , Infecciones por Bacterias Grampositivas/economía , Infecciones por Bacterias Grampositivas/epidemiología , Gastos en Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Factores SociodemográficosRESUMEN
BACKGROUND: Urinary tract infections (UTIs) are the most common infections caused by Gram-negative bacteria and represent a major healthcare burden. Carbapenem-resistant (CR) strains of Enterobacterales and non-lactose fermenting pathogens further complicate treatment approaches. METHODS: We conducted a retrospective analysis of the US Premier Healthcare Database (2014-2019) in hospitalised adults with a UTI to estimate the healthcare burden of Gram-negative CR UTIs among patients with or without concurrent bacteraemia. RESULTS: Among the 47,496 patients with UTI analysed, CR infections were present in 2076 (4.4%). Bacteraemia was present in 24.5% of all UTI patients, and 1.7% of these were caused by a CR pathogen. The most frequent CR pathogens were Pseudomonas aeruginosa (49.4%) and Klebsiella pneumoniae (14.2%). Patients with CR infections had a significantly longer hospital length of stay (LOS) (median [range] 8 [5-12] days vs 6 [4-10] days, P < 0.001), were less likely to be discharged home (38.4% vs 51.0%, P < 0.001), had a higher readmission rate (22.6% vs 13.5%, P < 0.001), and had greater LOS-associated charges (mean US$ 91,752 vs US$ 66,011, P < 0.001) than patients with carbapenem-susceptible (CS) infections, respectively. The impact of CR pathogens was greater in patients with bacteraemia (or urosepsis) and these CR urosepsis patients had a significantly higher rate of mortality than those with CS urosepsis (10.5% vs 6.0%, P < 0.001). CONCLUSIONS: Among hospitalised patients with UTIs, the presence of a CR organism and bacteraemia increased the burden of disease, with worse outcomes and higher hospitalisation charges than disease associated with CS pathogens and those without bacteraemia.
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Carbapenémicos/farmacología , Farmacorresistencia Bacteriana , Bacterias Gramnegativas/fisiología , Infecciones Urinarias/economía , Infecciones Urinarias/microbiología , Anciano , Anciano de 80 o más Años , Bacteriemia/economía , Bacteriemia/epidemiología , Bacteriemia/microbiología , Costo de Enfermedad , Femenino , Bacterias Gramnegativas/clasificación , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiologíaRESUMEN
BACKGROUND: Hospital-acquired bloodstream infection (BSI) is associated with high morbidity and mortality and increases patients' length of stay (LOS) and hospital charges. Our goals were to calculate LOS and charges attributable to BSI and compare results among different models. METHODS: A retrospective observational cohort study was conducted in 2017 in a large general hospital, in Beijing. Using patient-level data, we compared the attributable LOS and charges of BSI with three models: 1) conventional non-matching, 2) propensity score matching controlling for the impact of potential confounding variables, and 3) risk set matching controlling for time-varying covariates and matching based on propensity score and infection time. RESULTS: The study included 118,600 patient admissions, 557 (0.47%) with BSI. Six hundred fourteen microorganisms were cultured from patients with BSI. Escherichia coli was the most common bacteria (106, 17.26%). Among multi-drug resistant bacteria, carbapenem-resistant Acinetobacter baumannii (CRAB) was the most common (42, 38.53%). In the conventional non-matching model, the excess LOS and charges associated with BSI were 25.06 days (P < 0.05) and US$22041.73 (P < 0.05), respectively. After matching, the mean LOS and charges attributable to BSI both decreased. When infection time was incorporated into the risk set matching model, the excess LOS and charges were 16.86 days (P < 0.05) and US$15909.21 (P < 0.05), respectively. CONCLUSION: This is the first study to consider time-dependent bias in estimating excess LOS and charges attributable to BSI in a Chinese hospital setting. We found matching on infection time can reduce bias.
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Bacteriemia/economía , Infección Hospitalaria/economía , Costos de Hospital/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Tiempo de Internación/economía , Adulto , Anciano , Bacteriemia/etiología , Beijing , Infección Hospitalaria/microbiología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria/economía , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
BACKGROUND: Infections are common and are a major cause of morbidity and mortality during treatment of childhood leukemia. We evaluated the cost effectiveness of levofloxacin antibiotic prophylaxis, compared to no prophylaxis, in children receiving chemotherapy for acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia (ALL). PROCEDURES: A cost-utility analysis was conducted from the perspective of the single-payer health care system using a lifetime horizon. A comprehensive literature review identified available evidence for effectiveness, safety, costs of antibiotic prophylaxis in children with leukemia, and health utilities associated with the relevant health states. The effects of levofloxacin prophylaxis on health outcomes, quality-adjusted life-years (QALY), and direct health costs were derived from a combined decision tree and state-transition model. One-way deterministic and probabilistic sensitivity analyses were performed to test the sensitivity of results to parameter uncertainty. RESULTS: The literature review revealed one randomized controlled trial on levofloxacin prophylaxis in childhood AML and relapsed ALL, by Alexander et al, that showed a significant reduction in rates of fever and neutropenia (71.2% vs 82.1%) and bacteremia (21.9% vs 43.4%) with levofloxacin compared to no prophylaxis. In our cost-utility analysis, levofloxacin prophylaxis was dominant over no prophylaxis, resulting in cost savings of $542.44 and increased survival of 0.13 QALY. In probabilistic sensitivity analysis, levofloxacin prophylaxis was dominant in 98.8% of iterations. CONCLUSIONS: The present analysis suggests that levofloxacin prophylaxis, compared to no prophylaxis, is cost saving in children receiving intensive chemotherapy for AML or relapsed ALL.
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Profilaxis Antibiótica/economía , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Bacteriemia/economía , Análisis Costo-Beneficio , Leucemia Mieloide Aguda/economía , Levofloxacino/economía , Leucemia-Linfoma Linfoblástico de Células Precursoras/economía , Antibacterianos/economía , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/patología , Niño , Estudios de Seguimiento , Hospitalización , Humanos , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/patología , Levofloxacino/uso terapéutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Pronóstico , Años de Vida Ajustados por Calidad de VidaRESUMEN
BACKGROUND: Profound differences exist in the cost of burn care globally, thus we aim to investigate the affected factors and to delineate a strategy to improve the cost-effectiveness of burn management. METHODS: A retrospective analysis of 66 patients suffering from acute burns was conducted from 2013 to 2015. The average age was 26.7 years old and TBSA was 42.1% (±25.9%). We compared the relationship between cost and clinical characteristics. RESULTS: The estimated cost of acute burn care with the following formula (10,000 TWD) = -19.80 + (2.67 × percentage of TBSA) + (124.29 × status of inhalation injury) + (147.63 × status of bacteremia) + (130.32 × status of respiratory tract infection). CONCLUSION: The majority of the cost were associated with the use of antibiotics and burns care. Consequently, it is crucial to prevent nosocomial infection in order to promote healthcare quality and reduce in-hospital costs.
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Antibacterianos/economía , Bacteriemia/economía , Quemaduras/economía , Infección Hospitalaria/economía , Costos de la Atención en Salud , Neumonía Asociada al Ventilador/economía , Infección de Heridas/economía , Adolescente , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/prevención & control , Superficie Corporal , Quemaduras/patología , Quemaduras/terapia , Costos y Análisis de Costo , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/prevención & control , Manejo de la Enfermedad , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Neumonía Asociada al Ventilador/tratamiento farmacológico , Neumonía Asociada al Ventilador/prevención & control , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/prevención & control , Estudios Retrospectivos , Lesión por Inhalación de Humo , Taiwán , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/prevención & control , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the national trends in pediatric severe sepsis in the United States from 2003 to 2014. STUDY DESIGN: For this study, we included nonoverlapping years of Kids Inpatient database and National Inpatient Sample database while including hospitalizations of children between 1 and 20 years of age from more than 4200 hospitals across the United States. We identified patient hospitalizations with severe sepsis using specific ICD codes and modified Angus Criteria. Trend analysis of various factors associated with severe sepsis was calculated using the Cochrane-Armitage test. Associated foci of infection and comorbid conditions were identified using specific ICD codes, and a multivariate regression analysis with death as outcome variable was done to evaluate for in hospital predictors of mortality. RESULTS: Totally, 109,026 episodes of severe sepsis were identified during the study period between 2003 and 2014. Incidence of severe sepsis hospitalizations increased by 2.5 times (0.64-1.57 per 10,000 population) over the study period with notable concurrent significant decrease in mortality by more than 50%. Lower age, African American, Hispanic ethnicity, complex neurologic conditions, infective endocarditis, immunodeficient states including primary immunodeficiency disorder, HIV, burns, malignancy and transplant status are associated with mortality. There is a significant increase in use of healthcare resources (P < 0.001) with mean charges of 94,966$ despite a notable decrease in mean length of stay (22 vs. 16 days, P < 0.001) over the study period. CONCLUSION: Incidence of pediatric severe sepsis is high leading to a significant use of healthcare resources. This study provides a detailed analysis of associated inpatient factors and comorbidities associated with mortality.
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Bacteriemia/epidemiología , Mortalidad Hospitalaria/tendencias , Pacientes Internos/estadística & datos numéricos , Población , Sepsis/epidemiología , Sepsis/mortalidad , Adolescente , Bacteriemia/economía , Bacteriemia/mortalidad , Bacterias/clasificación , Bacterias/aislamiento & purificación , Bacterias/patogenicidad , Niño , Preescolar , Comorbilidad , Bases de Datos Factuales , Femenino , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Lactante , Masculino , Factores de Riesgo , Sepsis/economía , Sepsis/microbiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To estimate the attributable mortality, length of stay (LOS), and healthcare cost of pediatric and neonatal healthcare-acquired bloodstream infections (HA-BSIs). DESIGN: A systematic review and meta-analysis. METHODS: A systematic search (January 2000-September 2018) was conducted in PubMed, Cochrane, and CINAHL databases. Reference lists of selected articles were screened to identify additional studies. Case-control or cohort studies were eligible for inclusion when full text was available in English and data for at least 1 of the following criteria were provided: attributable or excess LOS, healthcare cost, or mortality rate due to HA-BSI. Study quality was evaluated using the Critical Appraisal Skills Programme Tool (CASP). Study selection and quality assessment were conducted by 2 independent researchers, and a third researcher was consulted to resolve any disagreements. Fixed- or random-effect models, as appropriate, were used to synthesize data. Heterogeneity and publication bias were evaluated. RESULTS: In total, 21 studies were included in the systematic review and 13 studies were included in the meta-analysis. Attributable mean LOS ranged between 4 and 27.8 days; healthcare cost ranged between $1,642.16 and $160,804 (2019 USD) per patient with HA-BSI; and mortality rate ranged between 1.43% and 24%. The pooled mean attributable hospital LOS was 16.91 days (95% confidence interval [CI], 13.70-20.11) and the pooled attributable mortality rate was 8% (95% CI, 6-9). A meta-analysis was not conducted for cost due to lack of eligible studies. CONCLUSIONS: Pediatric HA-BSIs have a significant impact on mortality, LOS, and healthcare cost, further highlighting the need for implementation of HA-BSI prevention strategies.
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Bacteriemia , Infección Hospitalaria , Costos de la Atención en Salud/estadística & datos numéricos , Tiempo de Internación , Sepsis , Adulto , Bacteriemia/economía , Bacteriemia/mortalidad , Estudios de Casos y Controles , Niño , Preescolar , Estudios de Cohortes , Infección Hospitalaria/economía , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sepsis/economía , Sepsis/mortalidad , Adulto JovenRESUMEN
Non-implanted central vascular catheters (CVC) are frequently required for therapy in hospitalized patients with hematological malignancies or solid tumors. However, CVCs may represent a source for bloodstream infections (central line-associated bloodstream infections, CLABSI) and, thus, may increase morbidity and mortality of these patients. A retrospective cohort study over 3 years was performed. Risk factors were determined and evaluated by a multivariable logistic regression analysis. Healthcare costs of CLABSI were analyzed in a matched case-control study. In total 610 patients got included with a CLABSI incidence of 10.6 cases per 1,000 CVC days. The use of more than one CVC per case, CVC insertion for conditioning for stem cell transplantation, acute myeloid leukemia, leukocytopenia (≤ 1000/µL), carbapenem therapy and pulmonary diseases were independent risk factors for CLABSI. Hospital costs directly attributed to the onset of CLABSI were 8,810 per case. CLABSI had a significant impact on the overall healthcare costs. Knowledge about risk factors and infection control measures for CLABSI prevention is crucial for best clinical practice.
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Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/epidemiología , Costos de la Atención en Salud/estadística & datos numéricos , Adulto , Factores de Edad , Bacteriemia/economía , Bacteriemia/microbiología , Bacterias/aislamiento & purificación , Estudios de Casos y Controles , Infecciones Relacionadas con Catéteres/economía , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/economía , Infección Hospitalaria/microbiología , Femenino , Neoplasias Hematológicas/terapia , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: In September 2016, the Korean National Health Insurance Service began reimbursing infection control (IC) costs on the condition that a certain number of doctors and full-time nurses for IC be allocated to supported hospitals. We analyzed the impact of the IC cost reimbursement policy on central line-associated bloodstream infections (CLABSIs). METHODS: A before-and-after study that analyzed the CLABSI rate trends between preintervention (January 2016 to February 2017) and intervention (March to December 2017) periods using autoregression time series analysis was performed in intensive care units (ICUs) at a 750-bed, secondary care hospital in Daegu, Republic of Korea. The enhanced IC team visited ICUs daily, monitored the implementation of CLABSI prevention bundles, and educated all personnel involved in catheter insertion and maintenance from March 2017. RESULTS: Autoregressive analysis revealed that the CLABSI rates per month in the preintervention and intervention periods were -0.256 (95% confidence interval, -0.613 to 0.101; Pâ¯=â¯.15) and -0.602 (95% confidence interval, -0.972 to -0.232; Pâ¯=â¯.008), respectively. The rates of compliance with maximal barrier precautions significantly improved from the preintervention (36.2%) to the intervention (77.9%) period (χ² test, P < .001). CONCLUSIONS: The IC cost reimbursement policy accelerated the decline in CLABSI rates significantly in monitored ICUs. A nationwide study to evaluate the effectiveness of the IC cost reimbursement policy for various health care-associated infections is warranted.
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Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Control de Infecciones/economía , Reembolso de Seguro de Salud/estadística & datos numéricos , Paquetes de Atención al Paciente/economía , Bacteriemia/economía , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/economía , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Adhesión a Directriz/economía , Humanos , Unidades de Cuidados Intensivos , Análisis de Regresión , República de Corea/epidemiologíaRESUMEN
BACKGROUND: For far too long, the diagnosis of bloodstream infections has relied on time-consuming blood cultures coupled with traditional organism identification and susceptibility testing. Technologies to define the culprit in bloodstream infections have gained sophistication in recent years, notably by application of molecular methods. CONTENT: In this review, we summarize the tests available to clinical laboratories for molecular rapid identification and resistance marker detection in blood culture bottles that have flagged positive. We explore the cost-benefit ratio of such assays, covering aspects that include performance characteristics, effect on patient care, and relevance to antibiotic stewardship initiatives. SUMMARY: Rapid blood culture diagnostics represent an advance in the care of patients with bloodstream infections, particularly those infected with resistant organisms. These diagnostics are relatively easy to implement and appear to have a positive cost-benefit balance, particularly when fully incorporated into a hospital's antimicrobial stewardship program.
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Programas de Optimización del Uso de los Antimicrobianos/tendencias , Bacteriemia/diagnóstico , Cultivo de Sangre/métodos , Servicios de Laboratorio Clínico/tendencias , Fungemia/diagnóstico , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/economía , Programas de Optimización del Uso de los Antimicrobianos/métodos , Bacteriemia/tratamiento farmacológico , Bacteriemia/economía , Bacteriemia/microbiología , Bacterias/genética , Bacterias/aislamiento & purificación , Proteínas Bacterianas/genética , Proteínas Bacterianas/aislamiento & purificación , Cultivo de Sangre/economía , Cultivo de Sangre/tendencias , Servicios de Laboratorio Clínico/economía , Servicios de Laboratorio Clínico/organización & administración , Análisis Costo-Beneficio , ADN Bacteriano/aislamiento & purificación , ADN de Hongos/aislamiento & purificación , Farmacorresistencia Bacteriana/genética , Farmacorresistencia Fúngica/genética , Proteínas Fúngicas/genética , Proteínas Fúngicas/aislamiento & purificación , Fungemia/tratamiento farmacológico , Fungemia/economía , Fungemia/microbiología , Hongos/genética , Hongos/aislamiento & purificación , Técnicas de Genotipaje/economía , Técnicas de Genotipaje/instrumentación , Técnicas de Genotipaje/métodos , Costos de la Atención en Salud , Humanos , Pruebas de Sensibilidad Microbiana/instrumentación , Pruebas de Sensibilidad Microbiana/métodos , Factores de Tiempo , Tiempo de TratamientoRESUMEN
INTRODUCTION: Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting. MATERIALS AND METHODS: This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective. RESULTS: 14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630). CONCLUSIONS: E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.
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Bacteriemia/economía , Costo de Enfermedad , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/economía , Bacteriemia/epidemiología , Inglaterra , Infecciones por Escherichia coli/epidemiología , Costos de Hospital , Hospitales/estadística & datos numéricos , HumanosRESUMEN
BACKGROUND: This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). METHODS: This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. RESULTS: There was no difference in mortality between the OS and non-OS groups (p = 0.06). Length of stay in the ICU (p = 0.029) was shorter and acute kidney injury incidence (p = 0.032) and costs of antimicrobial therapy (p < 0.001) were lower in the OS group. CONCLUSION: OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.
Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Lesión Renal Aguda/inducido químicamente , Administración Intravenosa , Administración Oral , Anciano , Antibacterianos/economía , Antibacterianos/uso terapéutico , Bacteriemia/economía , Brasil , Costos y Análisis de Costo , Estudios Transversales , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND AND AIMS: Complications such as blood stream infections (BSI) have been observed with the administration of parenteral nutrition (PN). Prior published studies reported the incidence of BSI for inpatient hospitalizations by comparing patients treated with custom compounded parenteral nutrition to those treated with premixed multichamber bag (MCB) formulations. Previous publications grouped patients treated with MCBs into a single category and no distinction was made between patients receiving only a MCB and those receiving a MCB supplemented with manual additions. This Study aims to assess differences in risk of blood stream infection, cost, and clinical outcomes among patients receiving multichamber bag parenteral nutrition products only (MCB-only), MCB with additions (MCB-addition), and compounded (COM) PN products using seven years of Premier Healthcare Data from 688 hospitals in the United States of America. METHODS: Adult inpatients who were discharged between 01/01/2008 and 12/31/2014, had a hospital length of stay ≥3 days and received PN during the index hospitalization were analyzed. PN preparation method was determined by billing charge descriptions. BSI was defined as having primary or secondary ICD-9 diagnosis codes of 038.x (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), and 790.7 (bacteremia). Multivariable regression models were used to assess effect of PN preparation on patient outcomes, adjusting for confounders. RESULTS: 84,564 patients were analyzed (MCB-only: 6.3%; MCB-addition: 14.8%; COM: 78.9%). Multivariable analysis indicated that compared to COM group, MCB-addition group had similar risk of BSI (7.0% vs. 6.8%, P > 0.05) and a 2.7% lower average total hospitalization cost ($28,072 vs. $28,861, P < 0.05) but had a higher PN treatment cost ($1135 vs. $1,031, P < 0.05) and a higher percentage of being discharged to rehabilitation or other acute care facilities (39.4% vs. 31.1%, P < 0.05). MCB-only group had lower risk of BSI and hospitalization cost. CONCLUSIONS: In the U.S., compounded PN is the most commonly used in clinical practice followed by MCB with additions. MCB-addition group had similar BSI risk with COM. The slightly lower overall cost in MCB-addition group may be offset by higher post-hospitalization care cost to providers and payers under bundled payment methods in the U.S.
Asunto(s)
Bacteriemia/epidemiología , Soluciones para Nutrición Parenteral/efectos adversos , Nutrición Parenteral Total/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/economía , Bacteriemia/etiología , Estudios Transversales , Femenino , Humanos , Revisión de Utilización de Seguros , Unidades de Cuidados Intensivos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Beta-lactams are the mainstay for treating methicillin-susceptible Staphylococcus aureus (MSSA) infections complicated by bacteremia due to superior outcomes compared with vancomycin. With approximately 11% of inpatients reporting a penicillin (PCN) allergy, many patients receive suboptimal treatment for MSSA bacteremia. OBJECTIVE: Evaluate the cost-effectiveness of penicillin skin testing (PST) in adult patients with self-reported PCN allergy in an inpatient setting undergoing treatment for MSSA bacteremia. METHODS: A decision analytic model was developed comparing an acute care PST intervention to a scenario with no confirmatory allergy testing. The primary outcome was the incremental cost-effectiveness ratio (ICER) from the health-sector perspective over a 1-year time horizon using quality-adjusted life years (QALYs) as the measure for effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the ICER estimation. RESULTS: Over a 1-year time horizon, PST services applied to all MSSA bacteremia patients reporting a PCN-allergy would result in a cost per patient of $12,559 and 0.73 QALYs while no PST services would have a higher cost per patient of $13,219 and 0.66 QALYs per patient. This resulted in a cost-effectiveness estimate of -$9,429 per QALY gained. Varying the cost of implementing PST services determined a break-even point of $959.98 where any PST cost less than this amount would actually be cost saving. CONCLUSIONS: Patients reporting a PCN allergy on admission may receive sub-optimal alternative therapies to beta-lactams, such as vancomycin, for MSSA bacteremia. This economic analysis demonstrates that inpatient PST services confirming PCN allergy are cost-effective for patients with MSSA bacteremia.
Asunto(s)
Antibacterianos/efectos adversos , Bacteriemia/economía , Análisis Costo-Beneficio , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/economía , Penicilinas/efectos adversos , Pruebas Cutáneas/economía , Infecciones Estafilocócicas/complicaciones , Adulto , Bacteriemia/diagnóstico , Bacteriemia/epidemiología , Bacteriemia/microbiología , Humanos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and are associated with significant morbidity and healthcare costs. The aim of our study was to determine the attributable length of stay (LOS) and cost for CLABSIs in pediatric patients in Greece, for which there is currently a paucity of data. METHODS: A retrospective matched-cohort study was performed in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units, hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to patients without CLABSI (non-CLABSIs) by hospital, unit, and LOS prior to study enrollment (188 children enrolled, 94 CLABSIs). The primary outcome measure was the attributable LOS and cost. Baseline demographic and clinical characteristics were recorded. Attributable outcomes were calculated as the differences in estimates of outcomes between CLABSIs and non-CLABSIs, after adjustment for propensity score and potential confounders. RESULTS: There were no differences between the two groups regarding their baseline characteristics. After adjustment for age, gender, matching characteristics, central line management after study enrollment, and propensity score, the mean LOS and cost were 57.5days and 31,302 in CLABSIs versus 36.6days and 17,788 in non-CLABSIs. Overall, a CLABSI was associated with a mean (95% CI) adjusted attributable LOS and cost of 21days (7.3-34.8) and 13,727 (5,758-21,695), respectively. No significant difference was detected in LOS and cost by hospitalization unit. CONCLUSIONS: CLABSIs were found to impose a significant economic burden in Greece, a finding that highlights the importance of implementing CLABSI prevention strategies.
Asunto(s)
Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Tiempo de Internación , Bacteriemia/economía , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/economía , Infecciones Relacionadas con Catéteres/prevención & control , Servicios de Salud del Niño/economía , Femenino , Grecia/epidemiología , Costos de la Atención en Salud , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation. METHODS: We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011. RESULTS: A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17). CONCLUSION: MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.
Asunto(s)
Bacteriemia/terapia , Endocarditis Bacteriana/terapia , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Infecciones Estafilocócicas/terapia , Bacteriemia/economía , Bacteriemia/microbiología , Bacteriemia/mortalidad , Endocarditis Bacteriana/economía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Costos de la Atención en Salud , Humanos , Tiempo de Internación , Medición de Riesgo , Factores de Riesgo , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Ninety percent of infants 29 to 60 days old presenting to the emergency department with fever and urinary tract infection are admitted due to fear of concomitant bacteremia. Many of these infants are at low risk for bacteremia and can be safely discharged with no heightened risk of adverse events. This study sought to estimate the potential savings from outpatient management of low-risk infants. METHODS: A comparative cost analysis was performed using bacteremia probability estimates from a previously published prediction model. We estimated costs using a national pediatric database coupled with retrospective chart review of infants who presented to our emergency department between 2011 and 2015. RESULTS: The relative cost savings for the discharge strategy were $80,333 ($19,127 vs $99,460; 80% savings) for each patient with bacteremia and $257,073 per 100 patients overall. Similar savings were found for charges-$304,949 ($71,421 vs $376,371; 80%) for each patient with bacteremia and $975,838 per 100 patients. Our institutional reimbursements provided an estimated savings of $148,924 ($73,280 vs. $222,204; 67%) and $476,533 per 100 patients overall. CONCLUSIONS: The relative cost savings from discharging rather than admitting low-risk infants with febrile urinary tract infection were significant, even accounting for expenditures associated with the return emergency room visit of initially discharged bacteremic patients. These savings are achievable without an increase in adverse events. Similar outcomes were demonstrated for hospital charges and reimbursements, further strengthening these results. This study emphasizes how risk stratification in clinical decision-making can lead to substantial cost savings without compromising patient outcomes.
Asunto(s)
Atención Ambulatoria/economía , Bacteriemia/epidemiología , Fiebre/terapia , Hospitalización/economía , Infecciones Urinarias/terapia , Bacteriemia/economía , Bacteriemia/terapia , Toma de Decisiones Clínicas , Costos y Análisis de Costo , Servicio de Urgencia en Hospital , Femenino , Fiebre/economía , Gastos en Salud , Humanos , Lactante , Masculino , Alta del Paciente , Estudios Retrospectivos , Medición de Riesgo , Infecciones Urinarias/economíaRESUMEN
BACKGROUND: Central venous catheters (CVC) have been widely used for patients with severe conditions. However, they increase the risk of catheter-related bloodstream infection (CRBSI), which is associated with high economic burden. Until now, no study has focused on the cost attributable to CRBSI in China, and data on its economic burden are unavailable. The aim of this study was to assess the cost attributable to CRBSI and its influencing factors. METHODS: A retrospective matched case-control study and multivariate analysis were conducted in a tertiary hospital, with 94 patients (age ≥ 18 years old) from January 2011 to November 2015. Patients with CRBSI were matched to those without CRBSI by age, principal diagnosis, and history of surgery. The difference in cost between the case group and control group during the hospitalization was calculated as the cost attributable to CRBSI, which included the total cost and five specific cost categories: drug, diagnostic imaging, laboratory testing, health care technical services, and medical material. The relation between the total cost attributable to CRBSI and its influencing factors such as demographic characteristics, diagnosis and treatment, and pathogenic microorganism, was analysed with a general linear model (GLM). RESULTS: The total cost attributable to CRBSI was $3528.6, and the costs of specific categories including drugs, diagnostic imaging, laboratory testing, health care technical services, and medical material, were $2556.4, $112.1, $321.7, $268.7, $276.5, respectively. GLM analysis indicated that the total cost was associated with the intensive care unit (ICU), pathogenic microorganism, age, and catheter number, according to the sequence of standardized estimate (ß). ICU contributed the most to the model R-square. CONCLUSION: Central venous catheter-related bloodstream infection represents a great economic burden for patients. More attentions should be paid to further prevent and control this infection in China.
Asunto(s)
Bacteriemia/economía , Infecciones Relacionadas con Catéteres/economía , Catéteres Venosos Centrales/economía , Costos de la Atención en Salud/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Adulto , Anciano , Bacteriemia/epidemiología , Bacteriemia/terapia , Estudios de Casos y Controles , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/terapia , Catéteres Venosos Centrales/estadística & datos numéricos , China , Femenino , Humanos , Unidades de Cuidados Intensivos/economía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención Terciaria/economía , Adulto JovenRESUMEN
PURPOSE: The implementation and optimization of molecular rapid diagnostic tests (mRDTs) as an antimicrobial stewardship intervention for patients with bloodstream infections (BSIs) are reviewed. SUMMARY: All U.S. acute care hospitals accredited by the Joint Commission are required to implement an antimicrobial stewardship program (ASP). Of the many interventions available to ASPs, mRDTs have demonstrated consistent, meaningful results on antimicrobial optimization and patient outcomes. Even among infectious diseases and antimicrobial stewardship-trained pharmacists, significant knowledge and familiarity gaps exist regarding available mRDTs and how best to implement and optimize them. Given the paucity of infectious diseases and/or antimicrobial stewardship-trained pharmacists, the mandates for establishing ASPs will require non-infectious diseases/antimicrobial stewardship-trained pharmacists to implement stewardship interventions, which may include mRDTs, within their institution. Optimization of mRDTs requires adequate diagnostic stewardship, specifically evaluating how mRDT implementation may decrease costs and assist in meeting antimicrobial stewardship regulatory requirements. Knowledge of how these technologies will augment existing microbiology and antimicrobial stewardship workflow is essential. Finally, selecting the right mRDT necessitates familiarity with the instrument's capabilities and with the institutional antibiogram. CONCLUSION: mRDTs have demonstrated the ability to be one of the most powerful antimicrobial stewardship interventions. Pharmacists required to implement an ASP in their institution should consider mRDTs as standard of care for patients with BSIs.