Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 21
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Einstein (Sao Paulo) ; 17(4): eGS4444, 2019 May 16.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116310

RESUMO

OBJECTIVE: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. METHODS: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). RESULTS: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. CONCLUSION: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.


Assuntos
Antibacterianos/economia , Hospitalização/economia , Infecções por Klebsiella/economia , Klebsiella pneumoniae , Antibacterianos/administração & dosagem , Proteínas de Bactérias , Feminino , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , beta-Lactamases
2.
World Neurosurg ; 128: e31-e37, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30928594

RESUMO

BACKGROUND: External ventricular drain (EVD) infections are a significant cause of morbidity among neurosurgical patients and have been correlated with increased length of hospital stay and longer requirements for intensive care. To date, no studies have examined the financial impact of EVD infections. METHODS: Patients who underwent EVD placement between December 2010 and January 2016 were included in the study. Clinical records were retrospectively reviewed and health care cost data were obtained from the hospital's finance department. Clinical information included patient demographics, details from the hospital course, and outcomes. Total costs, direct/indirect, and fixed/variable costs were analyzed for every patient. RESULTS: Over the 5-year study period, 246 EVDs were placed in 243 patients with an overall infection rate of 9.9% (N = 24). The median EVD duration for infected versus noninfected patients was 19 and 9 days, respectively (P < 0.0001). Median length of intensive care unit stay also was increased for patients with EVD infection (30 days vs. 13 days, P < 0.0001). Total health care costs were significantly greater for infected patients (US$ 168,692 vs. US$ 83,919, P < 0.0001). This trend was comparable for all other cost subtypes, including fixed-direct costs, fixed-indirect costs, variable direct costs, and variable-indirect costs. CONCLUSIONS: EVD infection has a substantial effect on clinical morbidity and healthcare costs. These results demonstrate the imperative need to improve EVD infection prevention, particularly in the setting of a value-based health care system.


Assuntos
Infecções Relacionadas a Cateter/economia , Hemorragia Cerebral/cirurgia , Ventriculite Cerebral/economia , Custos de Cuidados de Saúde , Complicações Pós-Operatórias/economia , Hemorragia Subaracnóidea/cirurgia , Ventriculostomia , Adulto , Idoso , Drenagem , Feminino , Infecções por Bactérias Gram-Negativas/economia , Infecções por Bactérias Gram-Positivas/economia , Humanos , Infecções por Klebsiella/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Infecções Estafilocócicas/economia , Estados Unidos
3.
Clin Infect Dis ; 67(suppl_2): S225-S230, 2018 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-30423052

RESUMO

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major health threat, but the economic impact of carbapenem resistance in K. pneumoniae infections remains largely uninvestigated. Methods: We constructed a retrospective cohort of all patients hospitalized at West China Hospital in 2017 who had CRKP- or carbapenem-susceptible K. pneumoniae (CSKP)-positive clinical samples. Propensity score matching (PSM) was used to control the impact of potential confounding variables, including demographics, comorbidities, and treatment, and to observe the impact of factors other than length of stay (LOS). Patients who survived were subjected to subgroup analyses stratified by infection type. Results: There were 267 patients with CRKP and 1328 with CSKP. Patients with CRKP had a higher crude in-hospital mortality rate (14.61% vs 5.65%, P < .05) and longer LOS (median, 31 vs 19 days; P < .05). PSM for demographics, comorbidities, and treatment generated 237 pairs. Patients with CRKP had higher medical costs than those with CSKP during the entire hospitalization (median, in US dollars, $22962 vs $11755, respectively; P < .05) and during the period after infection (median, $9215 vs $6904, respectively; P < .05). When LOS was matched, patients with CRKP still had high excess costs compared to those with CSKP (median, $22917 vs $13851, respectively, for the entire hospitalization, P < .05; $9101 vs $7001, respectively, after infection, P < .05). For infection type, the sample size generated sufficient power to compare only the patients with pneumonia. For surviving patients, high excess costs were observed in those with pneumonia caused by CRKP as compared to CSKP ($21890 vs $11698, respectively, for the entire hospitalization, P < .05; $9773 vs $5298, respectively, after infection, P < .05). Medicines other than antibacterial agents and nonmedicinal therapies contributed most (57.8%) of the excess costs associated with CRKP. Conclusions: Carbapenem resistance in K. pneumoniae was associated with increased medical costs not accounted for by the cost of antimicrobial therapy.


Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana , Custos Hospitalares , Hospitalização/economia , Infecções por Klebsiella/economia , Adulto , Idoso , Estudos de Casos e Controles , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/efeitos dos fármacos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
4.
JBI Database System Rev Implement Rep ; 16(2): 336-344, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29419620

RESUMO

REVIEW QUESTION/OBJECTIVE: The objective of this review is to evaluate the cost-effectiveness of antimicrobial therapy treatment for inpatients infected with Klebsiella pneumoniae carbapenemase.More specifically, the review question is: What is the best evidence on the cost-effectiveness of the antimicrobial treatment for inpatients infected with Klebsiella Pneumoniae Carbapenemase?"


Assuntos
Anti-Infecciosos/economia , Infecção Hospitalar/tratamento farmacológico , Pacientes Internados/estatística & dados numéricos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Proteínas de Bactérias , Análise Custo-Benefício , Infecção Hospitalar/economia , Humanos , Infecções por Klebsiella/economia , Projetos de Pesquisa , Revisão Sistemática como Assunto , beta-Lactamases
5.
Emerg Infect Dis ; 23(9): 1574-1576, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28820386
6.
BMC Infect Dis ; 17(1): 358, 2017 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28532467

RESUMO

BACKGROUND: Due to the vulnerable nature of its patients, the wide use of invasive devices and broad-spectrum antimicrobials used, the intensive care unit (ICU) is often called the epicentre of infections. In the present study, we quantified the burden of hospital acquired pathology in a Romanian university hospital ICU, represented by antimicrobial agents consumption, costs and local resistance patterns, in order to identify multimodal interventional strategies. METHODS: Between 1st January 2012 and 31st December 2013, a prospective study was conducted in the largest ICU of Western Romania. The study group was divided into four sub-samples: patients who only received prophylactic antibiotherapy, those with community-acquired infections, patients who developed hospital acquired infections and patients with community acquired infections complicated by hospital-acquired infections. The statistical analysis was performed using the EpiInfo version 3.5.4 and SPSS version 20. RESULTS: A total of 1596 subjects were enrolled in the study and the recorded consumption of antimicrobial agents was 1172.40 DDD/ 1000 patient-days. The presence of hospital acquired infections doubled the length of stay (6.70 days for patients with community-acquired infections versus 16.06/14.08 days for those with hospital-acquired infections), the number of antimicrobial treatment days (5.47 in sub-sample II versus 11.18/12.13 in sub-samples III/IV) and they increased by 4 times compared to uninfected patients. The perioperative prophylactic antibiotic treatment had an average length duration of 2.78 while the empirical antimicrobial therapy was 3.96 days in sample II and 4.75/4.85 days for the patients with hospital-acquired infections. The incidence density of resistant strains was 8.27/1000 patient-days for methicilin resistant Staphylococcus aureus, 7.88 for extended spectrum ß-lactamase producing Klebsiella pneumoniae and 4.68/1000 patient-days for multidrug resistant Acinetobacter baumannii. CONCLUSIONS: Some of the most important circumstances collectively contributing to increasing the consumption of antimicrobials and high incidence densities of multidrug-resistant bacteria in the studied ICU, are represented by prolonged chemoprophylaxis and empirical treatment and also by not applying the definitive antimicrobial therapy, especially in patients with favourable evolution under empirical antibiotic treatment. The present data should represent convincing evidence for policy changes in the antibiotic therapy.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Antibacterianos/economia , Antibacterianos/uso terapêutico , Anti-Infecciosos/economia , Antibioticoprofilaxia/economia , Antibioticoprofilaxia/estatística & dados numéricos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/economia , Infecções por Klebsiella/microbiologia , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Prospectivos , Romênia/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/economia , Infecções Estafilocócicas/microbiologia , beta-Lactamases/metabolismo
7.
Clin Microbiol Infect ; 23(3): 188-196, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27746394

RESUMO

OBJECTIVE: To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE). METHODS: We performed an observational economic evaluation of an outbreak of CPE (NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and 'opportunity cost' (staff time, bed closures and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10-month duration of the outbreak. RESULTS: The outbreak cost €1.1m over 10 months (range €0.9-1.4m), comprising €312 000 actual expenditure, and €822 000 (range €631 000-€1.1m) in opportunity cost. An additional €153 000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54 000 on anti-infectives for 18 patients treated, €94 000 on laboratory costs for screening, €73 000 on contact precautions for 1831 contact precautions patient-days, €42 000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43 000 on 2592 hours of ward-based monitors, and €6000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244 000 related to 1206 lost bed-days (range 366-2562 bed-days, €77 000-€512 000), €349 000 in missed revenue from 72 elective surgical procedures, and €228 000 in staff time (range €205 000-€251 000). Reduced capacity to perform elective surgical procedures related to bed closures (€349 000) represented the greatest cost. CONCLUSIONS: The cost estimates that we present suggest that CPE outbreaks are highly costly.


Assuntos
Proteínas de Bactérias/metabolismo , Infecção Hospitalar/economia , Surtos de Doenças/economia , Custos Hospitalares , Infecções por Klebsiella/economia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/metabolismo , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Hospitais , Humanos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Londres/epidemiologia
8.
Zhonghua Yi Xue Za Zhi ; 96(24): 1903-6, 2016 Jun 28.
Artigo em Chinês | MEDLINE | ID: mdl-27373357

RESUMO

OBJECTIVE: To evaluate the impact of extended-spectrum ß-lactamase (ESBL) on clinical outcome and medical cost in patients with bloodstream infection (BSI) due to Klebsiella pneumoniae. METHODS: A retrospective study was conducted in patients admitted into Changhai Hospital between January 2013 and December 2014, who suffered from BSI due to Klebsiella pneumoniae during hospitalization. Patients were divided into two groups according to whether Klebsiella pneumoniae produced ESBL (ESBL positive group and ESBL negative group). They were matched with propensity score matching method in a 1∶1 ratio and then multiple regression model was used to analyze the impact of ESBL on clinical outcome and medical cost. Clinical outcome was evaluated by 30-day mortality post BSI; medical cost was evaluated by total length of stay (LOS), post-BSI LOS, total hospital cost and antimicrobial cost. RESULTS: Before matching, the two groups were significantly different in age, nosocomial infection rate, LOS before BSI and surgical rate during hospitalization (all P<0.05). The ESBL-positive group had higher 30-day mortality post BSI (21.3% vs 8.7%, P=0.054), and higher total LOS [25.0(12.0, 33.0) vs 16.0(10.0, 23.0) d, P=0.015], post-BSI LOS [16.0(9.0, 26.0) vs 10.0(5.0, 16.0) d, P=0.006], total hospital cost [69 409(40 605, 198 021) vs 45 683(28 448, 67 000) ï¿¥, P<0.001] and antimicrobial cost [10 279(4 815, 25 500) vs 3 783(1 596, 11 879) ï¿¥, P<0.001]. After matching, the two groups had no significant differences in clinical characteristics such as sex, age, nosocomial infection rate, LOS before BSI, APACHEⅡ score, Charlson Comorbidity Index, underlying diseases and surgical rate during hospitalization (all P>0.05). Multiple regression analysis indicated that ESBL could significantly increase the total LOS, post-BSI LOS, total hospital cost and antimicrobial cost (all P<0.001), but did not increase the 30-day mortality post BSI (P=0.910). CONCLUSIONS: ESBL can significantly increase the medical cost in patients with BSI due to Klebsiella pneumoniae but does not increase the 30-day mortality post BSI.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/economia , Custos de Cuidados de Saúde , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/economia , Klebsiella pneumoniae/isolamento & purificação , Tempo de Internação/economia , beta-Lactamases/biossíntese , Antibacterianos/economia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Efeitos Psicossociais da Doença , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Infecções por Klebsiella/sangue , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Tempo de Internação/estatística & dados numéricos , Masculino , Análise Multivariada , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamases/metabolismo
9.
J Hosp Infect ; 92(1): 33-41, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26597637

RESUMO

BACKGROUND: Extended-spectrum ß-lactamase (ESBL)-producing bacteria are important sources of infection; however, Canadian data evaluating the impact of ESBL-associated infection are lacking. AIM: To determine whether patients infected with ESBL-producing Escherichia coli or Klebsiella species (ESBL-EcKs) exhibit differences in clinical outcome, microbiological outcome, mortality, and/or hospital resource use compared to patients infected with non-ESBL-producing strains. METHODS: A retrospective case-control study of 75 case patients with ESBL-EcKs matched to controls infected with non-ESBL-EcKs who were hospitalized from June 2010 to April 2013 was conducted. Patient-level cost data were provided by the institution's business office. Clinical data were collected using the electronic databases and paper charts. FINDINGS: Median infection-related hospitalization costs per patient were greater for cases than controls (C$10,507 vs C$7,882; median difference: C$3,416; P = 0.04). The primary driver of increased costs was prolonged infection-related hospital length of stay (8 vs 6 days; P = 0.02) with patient location (ward, ICU) and indirect care costs (including costs associated with infection prevention and control) as the leading cost categories. Cases were more likely to experience clinical failure (25% vs 11%; P = 0.03), with a higher all-cause mortality (17% vs 5%; P = 0.04). Less than half of case patients were prescribed appropriate empiric antimicrobial therapy, whereas controls received adequate initial treatment in nearly all circumstances (48% vs 96%; P < 0.01). CONCLUSION: Patients with infection caused by ESBL-EcKs are at increased risk for clinical failure and mortality, with additional cost to the Canadian healthcare system of C$3,416 per patient.


Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Custos de Cuidados de Saúde , Hospitalização/economia , Infecções por Klebsiella/microbiologia , Klebsiella/enzimologia , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Estudos de Casos e Controles , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/economia , Infecções por Escherichia coli/mortalidade , Infecções por Escherichia coli/patologia , Feminino , Humanos , Klebsiella/isolamento & purificação , Infecções por Klebsiella/economia , Infecções por Klebsiella/mortalidade , Infecções por Klebsiella/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
10.
J Microbiol Immunol Infect ; 48(2): 190-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24084377

RESUMO

BACKGROUND: Klebsiella pneumoniae liver abscess (KPLA) has emerged as an endemic disease in Taiwan, and its prevalence has been increasing in east Asian countries in the past three decades. The utilization of healthcare resources associated with KPLA is assumed to be substantial, and may be of future concern. This study investigated the clinical characteristics and economic burden of KPLA in Taiwan in 2011 and 2012. METHODS: Adult patients with KPLA were identified retrospectively in a tertiary medical center in Taiwan from January 2011 to December 2012. The clinical characteristics, total and daily hospitalization expenditure, and the risk factors for the costs of KPLA were analyzed. RESULTS: Among patients with KPLA, the median cost was $5290.80 in US dollars, and the mean cost was $6337.50 ± $4363.40. Length of hospital stay was the only independent risk factor for the high total hospitalization expenditure. The duration of antibiotic use was nearly the same as the length of hospital stay. The prolonged stay in the general ward (≥21 days) also contributed to the high total cost of hospitalization. The independent risk factors for the high average daily cost of hospitalization were a higher Charlson Comorbidity Index and the requirement of intensive care on admission. CONCLUSION: The current study is the first to demonstrate the high economic burden resulting from KPLA in a medical center in Taiwan. Standardizing the treatment protocol for KPLA inpatients and introducing an outpatient parenteral antimicrobial therapy center to reduce the length of stay may reduce costs, whereas development of a vaccine may be necessary to tackle endemic KPLA in the future.


Assuntos
Custos de Cuidados de Saúde , Infecções por Klebsiella/economia , Infecções por Klebsiella/patologia , Klebsiella pneumoniae/isolamento & purificação , Abscesso Hepático/economia , Abscesso Hepático/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Doenças Endêmicas , Feminino , Humanos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Abscesso Hepático/epidemiologia , Abscesso Hepático/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Centros de Atenção Terciária
11.
Infection ; 42(6): 991-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25100555

RESUMO

PURPOSE: The burden of extended-spectrum beta-lactamase (ESBL)-positive Enterobacteriaceae (ESBL-E) is growing worldwide. We aimed to determine the financial disease burden attributable to ESBL-positive species in cases of bloodstream infection (BSI) due to K. pneumoniae and E. coli. METHODS: We conducted a cohort study on patients with BSI due to K. pneumoniae or E. coli between 2008 and 2011 in our institution. Data were collected on true hospital costs, length of stay (LOS), basic demographic parameters, underlying diseases as Charlson comorbidity index (CCI) and ESBL positivity of the pathogens. Multivariable regression analysis on hospital costs and length of stay was performed. RESULTS: Overall we found 1,851 consecutive cases of ESBL-E BSI, 352 (19.0%) cases of K. pneumoniae BSI and 1,499 (81.0%) cases of E. coli BSI. Sixty-six of E. coli BSI (18.8%) and 178 of K. pneumoniae BSI (11.9%) cases were due to ESBL-positive isolates, respectively (p = 0.001). 830 (44.8%) cases were hospital-onset, 215 (61.1%) of the K. pneumoniae and 615 (41.0%) of the E. coli cases (p < 0.001). In-hospital mortality was overall 19.8, 25.0% in K. pneumoniae cases and 18.5% in E. coli cases (p = 0.006). Increased hospital costs and length of stay were significantly associated to BSI with ESBL-positive K. pneumoniae. CONCLUSION: In contrast to BSI due to ESBL-positive E. coli, cases of ESBL-positive K. pneumoniae BSI were associated with significantly increased costs and length of stay. Infection prevention measures should differentiate between both pathogens.


Assuntos
Bacteriemia/microbiologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/biossíntese , Idoso , Antibacterianos/farmacologia , Bacteriemia/economia , Bacteriemia/epidemiologia , Estudos de Coortes , Efeitos Psicossociais da Doença , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/economia , Infecções por Escherichia coli/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Infecções por Klebsiella/economia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resistência beta-Lactâmica
12.
Med Mal Infect ; 44(7): 321-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25022890

RESUMO

OBJECTIVES: We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours. PATIENTS AND METHODS: We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs. RESULTS: Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution. CONCLUSIONS: Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units.


Assuntos
Proteínas de Bactérias/análise , Portador Sadio , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/enzimologia , Custos Hospitalares/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Resistência beta-Lactâmica , beta-Lactamases/análise , Idoso , Carbapenêmicos/farmacologia , Portador Sadio/economia , Portador Sadio/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças/economia , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/economia , Infecções por Enterobacteriaceae/microbiologia , Feminino , França/epidemiologia , Unidades Hospitalares/economia , Hospitais Gerais/economia , Humanos , Controle de Infecções/economia , Unidades de Terapia Intensiva/economia , Infecções por Klebsiella/economia , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Isolamento de Pacientes/economia , Recursos Humanos em Hospital/economia , Estudos Retrospectivos
13.
Infect Control Hosp Epidemiol ; 35(1): 82-4, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24334803

RESUMO

Active surveillance to identify asymptomatic carriers of carbapenem-resistant Enterobacteriaceae (CRE) is a recommended strategy for CRE control in healthcare facilities. Active surveillance using stool specimens tested for Clostridium difficile is a relatively low-cost strategy to detect CRE carriers. Further evaluation of this and other risk factor-based active surveillance strategies is warranted.


Assuntos
Carbapenêmicos/farmacologia , Portador Sadio/diagnóstico , Fezes/microbiologia , Infecções por Klebsiella/diagnóstico , Klebsiella oxytoca/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Idoso , Portador Sadio/economia , Portador Sadio/microbiologia , Estudos de Casos e Controles , Clostridium difficile/isolamento & purificação , DNA Bacteriano/análise , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/microbiologia , Humanos , Infecções por Klebsiella/economia , Infecções por Klebsiella/microbiologia , Klebsiella oxytoca/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Pessoa de Meia-Idade , Vigilância em Saúde Pública/métodos , Resistência beta-Lactâmica
14.
Trials ; 14: 364, 2013 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-24176222

RESUMO

BACKGROUND: Klebsiella pneumoniae liver abscess is the most common etiology of liver abscess in Singapore and much of Asia, and its incidence is increasing. Current management includes prolonged intravenous antibiotic therapy, but there is limited evidence to guide oral conversion. The implicated K1/K2 capsule strain of Klebsiella pneumoniae is almost universally susceptible to ciprofloxacin, an antibiotic with high oral bioavailability. Our primary aim is to compare the efficacy of early (< one week) step-down to oral antibiotics, to continuing four weeks of intravenous antibiotics, in patients with Klebsiella liver abscess. METHODS/DESIGN: The study is designed as a multi-center randomized open-label active comparator-controlled non-inferiority trial, with a non-inferiority margin of 12%. Eligible participants will be inpatients over the age of 21 with a CT or ultrasound scan suggestive of a liver abscess, and Klebsiella pneumoniae isolated from abscess fluid or blood. Randomization into intervention or active control arms will be performed with a 1:1 allocation ratio. Participants randomized to active control will receive IV ceftriaxone 2 grams daily to complete a total of four weeks of IV antibiotics. Participants randomized to intervention will be immediately converted to oral ciprofloxacin 750 mg twice daily. At Week four, all participants will undergo abdominal imaging and be assessed for clinical response (CRP < 20 mg/l, absence of fever, plus scan showing that the maximal diameter of the abscess has reduced). If criteria are met, antibiotics are stopped; if not, oral antibiotics are continued, with reassessment for clinical response fortnightly. If criteria for clinical response are met by Week 12, the primary endpoint of clinical cure is met. A cost analysis will be performed to assess the cost saving of early conversion to oral antibiotics, and a quality of life analysis will be performed to assess whether treatment with oral antibiotics is less burdensome than prolonged IV antibiotics. DISCUSSION: Our results would help inform local and international practice guidelines regarding the optimal antibiotic management of Klebsiella liver abscess. A finding of non-inferiority may translate to the wider adoption of a more cost-effective strategy that reduces hospital length of stay and improves patient-centered outcomes and satisfaction. TRIAL REGISTRATION: Clinical trials gov NCT01723150.


Assuntos
Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Ciprofloxacino/administração & dosagem , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Abscesso Hepático/tratamento farmacológico , Projetos de Pesquisa , Administração Intravenosa , Administração Oral , Antibacterianos/economia , Ceftriaxona/economia , Ciprofloxacino/economia , Protocolos Clínicos , Análise Custo-Benefício , Esquema de Medicação , Custos de Medicamentos , Custos Hospitalares , Hospitais de Ensino , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/economia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Abscesso Hepático/diagnóstico , Abscesso Hepático/economia , Abscesso Hepático/microbiologia , Qualidade de Vida , Singapura , Fatores de Tempo , Resultado do Tratamento
15.
Nagoya J Med Sci ; 74(1-2): 93-104, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22515115

RESUMO

Some drug management systems have been established in Japanese hospitals to reduce medical costs and regulate drug usage. Among the many available prescription drugs, antimicrobials should be given special attention because their inappropriate use often leads to sudden outbreaks of resistant bacteria. As drug specialists, pharmacists should monitor the use of all drugs, particularly antimicrobials. Carbapenems are a class of broad-spectrum antimicrobials that are widely used to treat infections worldwide. However, their inappropriate use has led to an increase in the incidence of drug-resistant bacteria and consequently, medical costs, at hospitals. To reduce inappropriate use and drug resistance, we have established a permission system to control the use of carbapenems at the Japanese Red Cross Nagoya Daiichi Hospital. In this study, we retrospectively evaluated the applicability of the new permission system compared to that of the notification system and the non control system for 14 months each. The two management systems were able to maintain total antibiotic use density and control the outbreak of drug-resistant bacteria (P. aeruginosa, E. coli, and K. pneumoniae). The number of carbapenem prescriptions was decreased dramatically when this permission system was enforced. Compared to the non control system, the cost of antimicrobials was reduced by $757,470 for the 14-month study period using the permission system. These results suggest that our system to control the use of antimicrobials can efficiently suppress the incidence of drug-resistant bacteria and medical costs at hospitals.


Assuntos
Antibacterianos/economia , Antibacterianos/uso terapêutico , Carbapenêmicos/economia , Carbapenêmicos/uso terapêutico , Custos de Medicamentos , Farmacorresistência Bacteriana , Custos Hospitalares , Hospitais Gerais/economia , Controle de Infecções/economia , Serviço de Farmácia Hospitalar/economia , Análise Custo-Benefício , Uso de Medicamentos/economia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/economia , Infecções por Escherichia coli/microbiologia , Estudos de Viabilidade , Custos Hospitalares/organização & administração , Hospitais Gerais/organização & administração , Humanos , Prescrição Inadequada/economia , Prescrição Inadequada/prevenção & controle , Controle de Infecções/métodos , Japão , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/economia , Infecções por Klebsiella/microbiologia , Sistemas de Registro de Ordens Médicas/economia , Serviço de Farmácia Hospitalar/organização & administração , Padrões de Prática Médica/economia , Avaliação de Programas e Projetos de Saúde , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/economia , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Fatores de Tempo
16.
Crit Care Med ; 39(12): 2672-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21765349

RESUMO

OBJECTIVE: In 2005, there was an epidemic of infections resulting from extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in the intensive care department. The aim of this study was to evaluate the potential long-term clinical and economic benefits resulting from the management of this epidemic and the resulting changes in practices. DESIGN: Two periods were defined: the period leading up to and including the epidemic (2003-2005; period I) and the postepidemic period (2006-2008; period II). We estimated the number of nosocomial infections prevented between these two periods in three ways: comparison of attack rates, incidence rates, and calculation of standardized infection ratios. A cost-benefit analysis was then carried out by multiplying the number of nosocomial infections prevented by their cost as estimated from a literature review. MEASUREMENTS AND MAIN RESULTS: The characteristics of the populations hospitalized during these two periods were comparable in terms of age, sex, Simplified Acute Physiologic Scale II score, origin, and type of diagnosis. The death rate was similar in the two periods (21.8% vs. 23.3%; p = .63). The number of nosocomial infections prevented was 54.1 (95% confidence interval 25.8-83.1; 30.4, 95% confidence interval 5.3-54.9; 32.8, 95% confidence interval 6.0-63.7; and 30.1, 95% confidence interval 17.7-42.5) according to the methodology. The savings cost potentially associated with the infection control intervention ranged from €149,928 (USD $183,781) to €269,472 (USD $330,318). CONCLUSION: The management of this epidemic and the change in medical practices that it triggered were associated with a significant decrease in the number of infections acquired in the intensive care unit. There were substantial cost savings, highlighting the value of investment in the prevention of nosocomial infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Infecções por Klebsiella/prevenção & controle , Klebsiella pneumoniae , Antibacterianos/uso terapêutico , Análise Custo-Benefício , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/economia , Surtos de Doenças/economia , Feminino , Custos Hospitalares , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/economia , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Resistência beta-Lactâmica
17.
Infect Control Hosp Epidemiol ; 27(11): 1226-32, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17080381

RESUMO

OBJECTIVES: To evaluate the economic and clinical impact of infection with extended-spectrum beta -lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK). DESIGN: A matched-cohort analysis of the cost of illness. SETTING: An 810-bed, urban, community hospital in Hartford, Connecticut. PATIENTS: Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non-ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received. RESULTS: Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P=.034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days]; P=.006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P=.027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P=.013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen. CONCLUSION: The cost of non-urinary tract infections caused by ESBL-EK was 1.7 times the cost of non-urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.


Assuntos
Infecções por Escherichia coli , Escherichia coli/enzimologia , Custos Hospitalares , Infecções por Klebsiella , Klebsiella/enzimologia , beta-Lactamases/biossíntese , Adolescente , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Connecticut , Escherichia coli/classificação , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/economia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Feminino , Mortalidade Hospitalar , Hospitais Comunitários , Humanos , Lactente , Klebsiella/classificação , Klebsiella/efeitos dos fármacos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/economia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/mortalidade , Tempo de Internação , Masculino , Resistência beta-Lactâmica
18.
Antimicrob Agents Chemother ; 50(4): 1257-62, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16569837

RESUMO

We studied outcomes of extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae bacteremia. Inpatients with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella spp., or Proteus spp. (cases) were compared with patients with bacteremia caused by non-ESBL producers (controls). Outcomes included mortality, mortality due to infection, length of stay (LOS), delay in appropriate therapy (DAT), discharge to a chronic care facility, and hospital cost. Ninety-nine cases and 99 controls were enrolled. Thirty-five percent of cases died, versus 18% of controls (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3 to 4.7; P=0.01). Thirty percent of cases died due to infection, versus 16% of controls (OR, 2.3; 95% CI, 1.1 to 4.5; P=0.03). The median LOS after bacteremia for cases was 11 days (interquartile range, 5 to 21), versus 5 days for controls (interquartile range, 3 to 9) (P<0.001). DAT occurred in 66% of cases, versus 7% of controls (OR, 25.1; 95% CI, 10.5 to 60.2; P<0.001). Cases were more likely than controls to be discharged to chronic care (52% versus 21%; OR, 4.0; 95% CI, 1.9 to 8.3; P<0.001). The average hospital cost for cases was 65,509 Israeli shekels, versus 23,538 shekels for controls (P<0.001). After adjusting for differences between groups by using multivariable analysis, ESBL production remained a significant predictor of mortality (OR, 3.6; 95% CI, 1.4 to 9.5; P=0.008), increased LOS (1.56-fold; P=0.001), DAT (OR, 25.1; 95% CI, 10.5 to 60.2; P<0.001), and increased cost (1.57-fold; P=0.003). The mean increase in equivalent cost attributable to ESBL production was $9,620. ESBL production was associated with severe adverse outcomes, including higher overall and infection-related mortality, increased LOS, DAT, discharge to chronic care, and higher costs.


Assuntos
Bacteriemia/mortalidade , Infecções por Escherichia coli/mortalidade , Infecções por Klebsiella/mortalidade , Infecções por Proteus/mortalidade , beta-Lactamases/biossíntese , Adulto , Idoso , Bacteriemia/economia , Estudos de Coortes , Infecções por Escherichia coli/economia , Feminino , Hospitalização/economia , Humanos , Infecções por Klebsiella/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infecções por Proteus/economia , Estudos Retrospectivos
19.
Int J Infect Dis ; 10(1): 56-60, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16326126

RESUMO

INTRODUCTION: Klebsiella pneumoniae is of high prevalence in hospital infections, mainly in bloodstream infections (BSI), and some produce extended-spectrum beta-lactamase (ESBL). For hospitals with a high prevalence of strains producing this enzyme, there is no reference material to show whether the use of the E-test method for their detection, which can be quite expensive, is actually required. OBJECTIVE: To evaluate the cost-benefit of the disk diffusion and E-test methods for the detection of ESBL-producing K. pneumoniae strains in hospitals where a high prevalence of this resistance mechanism in BSI is found. METHODS: One hundred and eight patients with K. pneumoniae BSI were evaluated retrospectively. ESBL-producing strains were identified by the disk diffusion method and by the E-test method. We estimated the costs of both diagnostic methods based on antimicrobial therapy adequacy. RESULTS: Fifty-two percent of K. pneumoniae infections were due to ESBL-producing strains. The disk diffusion method yielded a positive predictive value (PPV) of 94.7% (95% CI: 88.9-100%) and a negative predictive value (NPV) of 96.1% (CI 95%: 90.8-101.4%) in relation to the E-test. We evaluated cost-effectiveness, i.e., we analyzed the cost of both E-test and disk diffusion methods with carbapenem and cephalosporins, and found that the use of the disk diffusion method accounts for approximately US$3300. CONCLUSIONS: In hospitals with a high prevalence of ESBL-producing strains, the disk diffusion method can be used to detect ESBL-producing K. pneumoniae without compromising the clinical progression of patients with BSI. The E-test showed higher accuracy but this method was more expensive than the disk diffusion method. However, the use of the E-test method was demonstrated to be more cost-effective, as we evaluated cost based on antimicrobial therapy adequacy.


Assuntos
Bacteriemia/economia , Infecções por Klebsiella/economia , Klebsiella pneumoniae/enzimologia , Centros Médicos Acadêmicos , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Brasil , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Cefalosporinas/farmacologia , Cefalosporinas/uso terapêutico , Estudos de Coortes , Custos e Análise de Custo , Hospitais , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Resultado do Tratamento , beta-Lactamases/metabolismo
20.
Infect Control Hosp Epidemiol ; 24(8): 601-6, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12940582

RESUMO

OBJECTIVES: To determine the costs of the interventions aimed at controlling the 4-month outbreak and to determine the attributable length of stay (LOS) associated with infection and colonization with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. DESIGN: A retrospective cost analysis was conducted from the hospital perspective. A micro-costing approach was employed. The LOS of four groups of hospitalized patients were compared with each other. National Perinatal Information Center criteria were used to stratify infants for severity of risk. The LOS of each group was compared with that of a national sample of similarly stratified infants. SETTING: A level III-IV, 45-bed neonatal intensive care unit. PATIENTS: Infant groups were infected (n = 8), colonized (n = 14), concurrent cohort (n = 54), and prior cohort (n = 486). RESULTS: The cost of the outbreak totaled 341,751 dollars. The largest proportion of costs was related to healthcare worker time providing direct patient care (2,489 hours at a cost of 146,331 dollars). Infected and colonized neonates had longer LOS than either the concurrent cohort or the prior cohort (P < .001). Compared with the national sample, infected infants had a 48.5-day longer mean LOS (95% confidence interval [CI95], 1.7 to 95.2), whereas the prior cohort's mean LOS was 6 days shorter (CI95, -9.4 to -2.9). CONCLUSIONS: This study increases the understanding of the burden of these multidrug-resistant organisms. Further research is needed to estimate the societal costs of these infections and the cost-effectiveness of preventive interventions.


Assuntos
Infecção Hospitalar/economia , Custos Hospitalares , Unidades de Terapia Intensiva Neonatal/economia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Infecções por Klebsiella/economia , Tempo de Internação , Antibacterianos/administração & dosagem , Antibacterianos/economia , Infecção Hospitalar/epidemiologia , Surtos de Doenças/economia , Humanos , Imipenem/administração & dosagem , Imipenem/economia , Recém-Nascido , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/patogenicidade , Cidade de Nova Iorque/epidemiologia , Vigilância de Evento Sentinela , beta-Lactamases/isolamento & purificação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA