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2.
BMC Health Serv Res ; 19(1): 743, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651305

RESUMO

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. METHODS: A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. RESULTS: Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 - 60,158) and $47,016 (23,125 - 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 - 13,180) and $14,847 (8445 - 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3-69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6-6.3) days. CONCLUSIONS: MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/economia , Idoso , Alberta , Antibacterianos/economia , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Meticilina/economia , Meticilina/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Rev Esc Enferm USP ; 53: e03486, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433016

RESUMO

OBJECTIVE: To evaluate the impact of Healthcare-Associated Infections on the hospitalization cost of children. METHOD: A prospective, quantitative cohort study involving children admitted to the Inpatient and Pediatric Intensive Care Units of a public university hospital. The data were analyzed through SPSS software by frequency distribution, central tendency measures and dispersion. The level of statistical significance was set at p<0.05 for all analyzes. RESULTS: The sample consisted of 173 children, of whom 18.5% developed Healthcare-Associated Infections, which increased the hospitalization costs 4.2 times (p<0.001). A greater cost impact was observed among patients with two or more infectious sites (R$81,037.57; p=0.010) and sepsis (R$46,315.63; p<0.001). Children colonized by multiresistant microorganisms with a prevalence of E. coli and A. baumannii ESBL also generated higher costs of R$35,206.15 and R$30,692.52, respectively. CONCLUSION: Healthcare-Associated Infections significantly increased the hospitalization costs for children, especially among those with more than two infectious sites, who developed sepsis or were colonized by multiresistant microorganisms.


Assuntos
Infecção Hospitalar/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Sepse/epidemiologia , Adolescente , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Estudos Prospectivos , Sepse/economia
4.
Int J Infect Dis ; 86: 25-30, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31189085

RESUMO

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low- and middle-income countries. Existing data suggests that hospital patients in low- and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low- and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion.


Assuntos
Higiene das Mãos/economia , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Pessoal de Saúde/economia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Renda
5.
PLoS One ; 14(5): e0217159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31100094

RESUMO

INTRODUCTION: Healthcare-associated infections (HAIs) are a major health concern and have substantial effects on morbidity and mortality and increase healthcare costs. We investigated the effect of a hospital-wide program for the prevention of HAIs on additional length of stay (LOS). METHODS: We analyzed data from a prospective, single-center, quasi-experimental study with two surveillance periods before and after implementation of an infection prevention intervention program. HAI diagnosis was made according to surveillance definition criteria established by the US Centers for Disease Control and Prevention. A multistate model was used to estimate additional LOS for patients with HAI in both surveillance periods. RESULTS: During the first and second periods, 1,568 and 2,336 HAIs were identified among 26,943 and 35,211 patients, respectively. For HAI patients exclusively treated in a general ward, additional LOS was 8.4 (95% confidence interval, CI: 6.8-10.0) days in the first period and 9.6 (95% CI: 8.3-11.0) days in the second period (p = 0.26). For HAI patients treated in both an intensive care unit (ICU) and a general ward, additional LOS was 8.1 (95% CI: 6.3-9.9) days in the first period to 7.3 (95% CI: 6.1-8.5) days in the second period (p = 0.47). CONCLUSIONS: Healthcare-associated infections prolong LOS. A hospital-wide infection control program did not alter the prolongation of LOS.


Assuntos
Infecção Hospitalar/epidemiologia , Implementação de Plano de Saúde , Hospitais/estatística & dados numéricos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Idoso , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Estudos Prospectivos
6.
Biomed Res Int ; 2019: 7634528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949509

RESUMO

Healthcare associated infection (HAI) is known to increase the economic burden of patients while the medical cost due to MDRO HAI is even higher. Three hundred eighty-one multidrug resistance organisms (MDROs) healthcare associated infection (HAI) case-patients and three hundred eighty-one matched control-patients were identified between January and December in 2015. The average total hospitalization medical cost of the case group was $6127.65 and that of the control group was $2274.02. The difference between the case group and the control group was statistically significant (t = 21.07; P < 0.01). The attributable cost of MDRO HAI was $3853.63. The direct medical costs due to different MDRO infections were different. The increased medical costs of CR-AB, CR-KP, and CR-PA were significantly higher than that of MRSA, MRSE, ESBL E. coli, and ESBL Kp (P < 0. 05). Among the subitem expenses, the drug cost increased the most (the average cost was $1457.72), followed by the treatment fee and test fee; the differences were statistically significant (P < 0.01).


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas , Infecção Hospitalar , Farmacorresistência Bacteriana Múltipla , Hospitalização , Hospitais , Idoso , Bactérias/classificação , Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , China/epidemiologia , Custos e Análise de Custo , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/terapia , Feminino , Humanos , Masculino
7.
Biomedica ; 39(1): 102-112, 2019 03 31.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31021551

RESUMO

Introduction: The cost analysis of infections associated with health care represents a challenge for the health system in Colombia given their determinants. Objective: To determine the factors related to the increase and variability in the costs of hospital care for infections associated with health care in a fourth-level hospital in Bogotá from 2011 to 2015. Materials and methods: The costs of the care for 292 patients were analyzed including each of the activities carried out since the suspicion of the infectious disease until its resolution. These costs were standardized to the value of the Instituto de Seguros Sociales tariff manual adjusted by the annual consumer price index for health until 2014. The factors related to the increase in management costs were identified using a conditional logistic regression model. Results: A hospital stay of nine days or more prior to the infection was a factor associated with the increase of direct costs in the management of infections associated with health care (OR=2.06; 95% CI: 1.11-3.63). The median cost of the infections was COP $1.190.879. The antibiotic treatment represented 41% of the total value of the treatment, followed by laboratory tests with a cost equivalent to 13.5%. Conclusions: We found a relationship between the cost of the management of infections associated with health care and the hospital stay prior to their appearance. The pathological antecedents of the patients were not related to the increase in the cost.


Assuntos
Infecção Hospitalar/economia , Custos Hospitalares , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colômbia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/terapia , Feminino , Custos Hospitalares/estatística & dados numéricos , Custos Hospitalares/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
8.
Eur J Clin Microbiol Infect Dis ; 38(7): 1297-1305, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30941532

RESUMO

To investigate the predictors and burden of hospital readmission with recurrent Clostridioides difficile infection (rCDI) in a large European healthcare system with a low prevalence of hyper-virulent C. difficile clones. We conducted an inception cohort study based on an exhaustive health insurance database and including all survivors of a first hospital stay with CDI over a one-year period (2015) in France. Readmissions with rCDI were defined as a novel hospital stay with CDI within 12 weeks following discharge of the index hospitalization. Risk factors for readmission with rCDI were investigated through multivariate logistic regression analyses. Among the 14,739 survivors of the index hospital stay (females, 57.3%; median age, 74 [58-84] years), 2135 (14.5%) required at least one readmission with rCDI. Independent predictors of readmission were age ≥ 65 years (adjusted odds ratio (aOR), 1.34, 95% confidence interval (CI), 1.21-1.49, P < 0.0001), immunosuppression (aOR, 1.27, 95% CI, 1.15-1.41, P < 0.0001), chronic renal failure (aOR, 1.29, 95% CI, 1.14-1.46, P < 0.0001), and a previous history of CDI (aOR, 2.05, 95% CI, 1.55-2.71, P < 0.0001). The cumulative number of risk factors was independently associated with the hazard of readmission. Mean acute care costs attributable to rCDI were 5619 ± 3594 Euros for readmissions with rCDI as primary diagnosis (mean length of stay, 11.3 ± 10.2 days) and 4851 ± 445 Euros for those with rCDI as secondary diagnosis (mean length of stay, 16.8 ± 18.2 days), for an estimated annual nation-wide cost of 14,946,632 Euros. Hospital readmissions with rCDI are common after an index episode and drive major healthcare expenditures with substantial bed occupancy, strengthening the need for efficient secondary prevention strategies in high-risk patients.


Assuntos
Infecções por Clostridium/epidemiologia , Efeitos Psicossociais da Doença , Infecção Hospitalar/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Infecções por Clostridium/economia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Feminino , França/epidemiologia , Custos de Cuidados de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Recidiva , Estudos Retrospectivos , Fatores de Risco
9.
Curr Pharm Biotechnol ; 20(8): 625-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30961487

RESUMO

BACKGROUND: Healthcare Associated Infections (HAIs) represent a crucial issue in health and patient safety management due to the persistent nature, economic impact and possible preventability of the phenomenon. Compensation claims for damages resulting from HAI could provide insights that can improve the understanding of suboptimal steps in the therapeutic process, enable an estimate of costs related to infectious complications, and guide the development of planning tools for implementation of the quality of care. OBJECTIVE: This paper analyzes all the HAI claims received at the Umberto I General Hospital of Rome across a five-year period with the aim of outlining a methodological approach to the litigation management and of characterizing the economic impact of infections on health facilities resources. METHODS: All claims received during the study period have been classified according to the International Classification for Patient Safety (ICPS) system. Subsequently, claims related to Healthcare Associated Infections were evaluated through an innovative tool for determination of the risk of loss, the Advanced Loss Eventuality Assessment (ALEA) score. RESULTS: The results obtained demonstrate the relevance of a correct management of HAI claims in the administration of a health care system. Specifically, the cases examined during the study highlighted the significant impact of infectious diseases of a nosocomial nature in terms of frequency and economic exposure. CONCLUSION: The proposed methodological approach allows a productive analysis of the internal processes, providing fundamental data for the refinement of the preventive strategies and for the rationalization of the resources through the expenditure forecasts. Article Highlights Box: Healthcare-Associated Infections represent an essential element to consider in the management of health facilities. • Many studies highlight the economic burden of Healthcare-Associated Infections in health policies. • Litigation management represents a useful resource in the prevention of Healthcare Associated Infections. • Appropriate clinical risk management policies in the field of Healthcare-Associated Infections allow the implementation of preventive measures, the reduction of the incidence of the phenomenon and the quality of care. • The costs of Healthcare-Associated Infections can be limited through a systematic methodological approach based on Advanced Loss Eventuality Assessment and technical estimate of the value of each case. • The application of a standardized system would be desirable in any health facility despite the potential methodological, technical, behavioral and financial issues.


Assuntos
Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Assistência à Saúde/normas , Controle de Infecções/organização & administração , Guias de Prática Clínica como Assunto/normas , Infecção Hospitalar/epidemiologia , Humanos , Incidência , Controle de Infecções/economia , Controle de Infecções/normas , Melhoria de Qualidade , Roma
10.
Curr Pharm Biotechnol ; 20(8): 643-652, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30961489

RESUMO

BACKGROUND: The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. OBJECTIVE: The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital. METHODS: The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant'Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost. RESULTS: Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient. CONCLUSION: The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.


Assuntos
Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Custos Hospitalares , Tempo de Internação/economia , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecção Hospitalar/economia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Roma
11.
J Infect Public Health ; 12(4): 568-575, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30824329

RESUMO

BACKGROUND: In 2018, diagnosis-related group-based prospective payment system (DRG-PPS) was implemented nationwide by China that did not fully consider the additional costs caused by healthcare-associated infections (HAIs). HAIs can increase hospitalization costs, but only a few studies have been conducted in China. We aimed to assess the additional costs caused by HAIs. METHODS: A retrospective matched case-control (1:1) study was performed in one of the largest tertiary hospitals in Sichuan Province, China. A multiple linear regression was used to identify confounding factors, and the propensity score matching (PSM) method was used to balance confounding factors between cases and controls. On this basis, we estimated the additional costs caused by HAIs. RESULTS: Of the 109,294 inpatients observed, 1912 had HAI. After the PSM method was implemented, 1686 cases were successfully matched. Median hospitalization costs were €5613.03 for patients with HAIs and €3414.83 for patients without HAIs (P < 0.001), resulting in an absolute difference of €2198.19. With the exception of pathological diagnosis costs, surgical treatment costs and disposable medical material costs for surgery, all other types of costs for the cases with HAIs were larger. CONCLUSIONS: Patients with HAIs incurred greater hospitalization costs than non-HAI patients, which warrants closer attention if we are to reform the payment method of medical insurance in China.


Assuntos
Infecção Hospitalar/economia , Custos Hospitalares , Hospitalização/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , China , Infecção Hospitalar/diagnóstico , Feminino , Gastos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Centros de Atenção Terciária
12.
Rev Esp Quimioter ; 32(2): 165-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30880377

RESUMO

This paper seeks to explore the reasons for the low impact of nosocomial infection in the mainstream media and the responsibilities of physicians and journalists in terms of this situation. To this end, a small group of 13 experts met for round-table discussions, including physicians with expertise in nosocomial infection, medical lawsuits and ethics, as well as journalists from major mainstream Spanish media outlets. The various participants were asked a series of questions prior to the meeting, which were answered in writing by one of the speakers and discussed during the meeting by the whole group, the aim being to obtain consensual conclusions for each of them. The document was subsequently reviewed, edited and forwarded to all co-authors for their agreement. The opinions expressed are the personal opinions of the participants and not necessarily those of the institutions in which they work or with which they collaborate.


Assuntos
Infecção Hospitalar/epidemiologia , Meios de Comunicação de Massa , Atitude , Infecção Hospitalar/economia , Humanos , Jornalismo , Qualidade da Assistência à Saúde , Espanha/epidemiologia
13.
J Infus Nurs ; 42(2): 61-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817421

RESUMO

The economic impacts from preventing health care-associated infections (HAIs) can differ for patients, health care providers, third-party payers, and all of society. Previous studies from the provider perspective have estimated an economic burden of approximately $10 billion annually for HAIs. The impact of using a societal cost perspective has been illustrated by modifying a previously published analysis to include the economic value of mortality risk reductions. The resulting costs to society from HAIs exceed $200 billion annually. This article describes an alternative hospital accounting framework outlining the cost of a quality model which can better incorporate the broader societal cost of HAIs into the provider perspective.


Assuntos
Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Custos de Cuidados de Saúde , Humanos , Modelos Econômicos
14.
Proc Natl Acad Sci U S A ; 116(13): 6221-6225, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30858309

RESUMO

Healthcare-associated infections (HAIs) pose a significant burden to patient safety. Institutions can implement hospital infection control (HIC) measures to reduce the impact of HAIs. Since patients can carry pathogens between institutions, there is an economic incentive for hospitals to free ride on the HIC investments of other facilities. Subsidies for infection control by public health authorities could encourage regional spending on HIC. We develop coupled mathematical models of epidemiology and hospital behavior in a game-theoretic framework to investigate how hospitals may change spending behavior in response to subsidies. We demonstrate that under a limited budget, a dollar-for-dollar matching grant outperforms both a fixed-amount subsidy and a subsidy on uninfected patients in reducing the number of HAIs in a single institution. Additionally, when multiple hospitals serve a community, funding priority should go to the hospital with a lower transmission rate. Overall, subsidies incentivize HIC spending and reduce the overall prevalence of HAIs.


Assuntos
Infecção Hospitalar/epidemiologia , Teoria do Jogo , Hospitais , Controle de Infecções , Modelos Teóricos , Orçamentos , Infecção Hospitalar/economia , Resistência Microbiana a Medicamentos , Economia Hospitalar , Custos Hospitalares , Humanos , Prevalência
15.
Health Serv Res ; 54(4): 782-792, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30864179

RESUMO

OBJECTIVE: To estimate the cost of infections associated with multidrug-resistant organisms (MDROs) during inpatient hospitalization in the United States. DATA SOURCES/STUDY SETTING: 2014 National Inpatient Sample. STUDY DESIGN: Multivariable regression models assessed the incremental effect of MDROs on the cost of hospitalization and hospital length of stay among patients with bacterial infections. DATA COLLECTION/EXTRACTION METHODS: We retrospectively identified 6 385 258 inpatient stays for patients with bacterial infection. PRINCIPAL FINDINGS: The national incidence rate of inpatient stays with bacterial infection is 20.1 percent. At least 10.8 percent of such stays-and as many as 16.9 percent if we account for undercoded infections-show evidence of one or more MDROs. MRSA, C. difficile, infection with another MDRO, and the presence of more than one MDRO are associated with $1718 (95% CI, $1609-$1826), $4617 (95% CI, $4407-$4827), $2302 (95% CI, $2044-$2560), and $3570 (95% CI, $3019-$4122) in additional costs per stay, respectively. The national cost of infections associated with MDROs is at least $2.39 billion (95% CI, $2.25-$2.52 billion) and as high as $3.38 billion (95% CI, $3.13-$3.62 billion) if we account for undercoded infections. CONCLUSIONS: Infections associated with MDROs result in a substantial cost burden to the US health care system.


Assuntos
Infecções Bacterianas/economia , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Hospitais/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Economia Hospitalar , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Características de Residência , Estudos Retrospectivos , Terapia Socioambiental
16.
JAMA Pediatr ; 173(3): 260-268, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640369

RESUMO

Importance: Pediatric transplant recipients are at risk for vaccine-preventable infections owing to immunosuppression, suboptimal response to vaccines before and after transplant, and potential underimmunization if transplant occurred early in life. However, the incidence and burden of illness from vaccine-preventable infections in this population is unknown. Objectives: To evaluate in pediatric solid organ transplant recipients the number of hospitalizations for vaccine-preventable infections in the first 5 years after transplant and to determine the associated morbidity, mortality, and costs. Design, Setting, and Participants: A retrospective cohort study from January 1, 2004, to December 31, 2011, with 5 years of follow-up per participant (unless they died during the study period). The participants of this multicenter study through the Pediatric Health Information System were solid organ transplant recipients who were younger than 18 years at the time of transplant. Analysis began in July 2017. Exposures: Transplant. Main Outcomes and Measures: Hospitalizations for a vaccine-preventable infection during the first 5 years after transplant were ascertained using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, clinical modification diagnosis codes. Data were collected on clinical care, outcomes, and costs during these hospitalizations. Results: Of 6980 transplant recipients identified, there were 3819 boys (54.7%), and the mean (SD) age at transplant was 8 (6.2) years. Overall, 1092 patients (15.6%) had a total of 1471 cases of vaccine-preventable infections. There were 187 of 1471 cases (12.7%) that occurred during transplant hospitalization. The case fatality rate was 1.7% for all infections. Excluding infections that occurred during transplant hospitalization (when all patients go to the intensive care unit), 213 of 1257 patients (17.0%) were hospitalized with a vaccine-preventable infection requiring intensive care. In multivariable analysis, age younger than 2 years at time of transplant and receipt of a lung, heart, intestine, or multivisceral organ were positively associated with increased risk of a hospitalization from a vaccine-preventable infection.Transplant hospitalizations complicated by vaccine-preventable infections were $120 498 more expensive (median cost) than transplant hospitalizations not complicated by vaccine-preventable infections. Conclusions and Relevance: Hospitalization for vaccine-preventable infections occurred in more than 15% of solid organ transplant recipients in the first 5 years after transplant at a rate of up to 87 times higher than in the general population. There was significant morbidity, mortality, and costs from these infections, demonstrating the importance of immunizing all transplant candidates and recipients. Further research on improving immunization delivery, preventing nosocomial infections, and monitoring response to vaccines in the transplant population is needed.


Assuntos
Infecção Hospitalar/prevenção & controle , Custos Hospitalares , Hospitalização/estatística & dados numéricos , Transplante de Órgãos/efeitos adversos , Vacinação/economia , Vacinas/farmacologia , Criança , Pré-Escolar , Análise Custo-Benefício , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Masculino , Morbidade/tendências , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
17.
J Hosp Infect ; 102(2): 141-147, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30690051

RESUMO

BACKGROUND: Healthcare-acquired Clostridium difficile infection (HA-CDI) is a common infection and a financial burden on the healthcare system. AIM: To estimate the hospital-based financial costs of HA-CDI by comparing time-fixed statistical models that attribute cost to the entire hospital stay to time-varying statistical models that adjust for the time between admission, diagnosis of HA-CDI, and discharge and that only attribute HA-CDI costs post diagnosis. METHODS: A retrospective cohort study was conducted (April 2008 to March 2011) using clinical and administrative costing data of inpatients (≥15 years) who were admitted to The Ottawa Hospital with stays >72 h. Two time-fixed analyses, ordinary least square regression and generalized linear regression, were contrasted with two time-dependent approaches using Kaplan-Meier survival curve. FINDINGS: A total of 49,888 admissions were included and 366 (0.73%) patients developed HA-CDI. Estimated total costs (Canadian dollars) from time-fixed models were as high as $74,928 per patient compared to $28,089 using a time-varying model, and these were 1.47-fold higher compared to a patient without HA-CDI (incremental cost $8,997 per patient). The overall annual institutional cost at The Ottawa Hospital associated with HA-CDI was as high as $10.07 million using time-fixed models and $1.62 million using time-varying models. CONCLUSION: When calculating costs associated with HA-CDI, accounting for the time between admission, diagnosis, and discharge can substantially reduce the estimated institutional costs associated with HA-CDI.


Assuntos
Infecções por Clostridium/economia , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Custos de Cuidados de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos Retrospectivos , Adulto Jovem
18.
Cancer ; 125(9): 1404-1409, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30695098

RESUMO

Plans to optimize health care in the United States highlight the high cost but rarely explore opportunities for redirecting resources within the existing system to increase access to care while lowering spending. This analysis indicates that, of the total national health care expenditures of $3.21 trillion in 2015, only $1.4 trillion to $2.86 trillion was used to provide care to patients. This range was reached by the subtraction of excess spending in 7 categories. Thus, many opportunities exist to repurpose wasted expenditures to increase access to health care without the need for additional funding.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Redução de Custos , Análise Custo-Benefício , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/terapia , Assistência à Saúde/organização & administração , Eficiência Organizacional/economia , Feminino , Fraude/economia , Fraude/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Mau Uso de Serviços de Saúde/economia , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Masculino , Erros Médicos/economia , Erros Médicos/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
Expert Rev Pharmacoecon Outcomes Res ; 19(3): 305-312, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30321493

RESUMO

Background - Antimicrobial resistance (AMR) is a major health threat worldwide as it brings about poorer outcomes and places economic burdens to society. This study aims to estimate the economic burdens from nosocomial infections (NI) caused by multi-drug resistant (MDR) bacteria in Thailand. Research design and methods - A retrospective cohort study was conducted at a tertiary hospital over 2011-2012. A multivariate log-linear regression model was used to estimate the excess treatment costs of AMR to those non-AMR patients. Results - Switching from a non-AMR case to an AMR infection case, resulted in 42% increase in expected average treatment costs per patient. The annual treatment from hospital perspective and antibiotic costs associated with the management of AMR infections were estimated to be US$ 2.3 billion and US$ 262 million, respectively. The estimated annual benefit from eradicating AMR NI were US$ 4.2 billion from a societal perspective with the annual gains in quality-adjusted life years (QALYs) of 0.6 million due to the absence of 111,295 AMR cases each year. Conclusions - Large amount of money was spent on treatment and antibiotic costs to manage AMR infections. Benefit of eliminating these infections was estimated and it would be highly cost-effective.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/epidemiologia , Efeitos Psicossociais da Doença , Infecção Hospitalar/epidemiologia , Idoso , Antibacterianos/economia , Antibacterianos/farmacologia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/economia , Estudos de Coortes , Análise Custo-Benefício , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/economia , Farmacorresistência Bacteriana Múltipla , Feminino , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Centros de Atenção Terciária , Tailândia/epidemiologia
20.
Eur J Clin Microbiol Infect Dis ; 38(2): 319-323, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30426331

RESUMO

The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multidrug-resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious MDR bacteria present at intensive care units (ICU) that have become a threat in clinical practice. A proposal addressing a PPL for ICU, arising from the WHO Global PPL, was developed. Based on the supporting data, the pathogens were grouped in three priority tiers: critical, high, and medium. A multi-criteria decision analysis (MCDA) was used to identify the priority tiers. After MCDA, mortality, treatability, and cost of therapy were of highest concern (scores of 19/20, 19/20, and 15/20, respectively) while dealing with PPL, followed by healthcare burden and resistance prevalence. Carbapenem-resistant (CR) Acinetobacter baumannii, carbapenemase-expressing Klebsiella pneumoniae (KPC), and MDR Pseudomonas aeruginosa were identified as critical organisms. High-risk organisms were represented by CR Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae. Finally, ESBL Serratia marcescens, vancomycin-resistant Enterococci, and TMP-SMX-resistant Stenotrophomonas maltophilia were identified as medium priority. We conclude that education, investigation, funding, and development of new antimicrobials for ICU organisms should focus on carbapenem-resistant Gram-negative organisms.


Assuntos
Bactérias/classificação , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva/normas , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/economia , Técnicas de Apoio para a Decisão , Humanos , Controle de Infecções/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Guias de Prática Clínica como Assunto
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