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1.
Clin Microbiol Infect ; 25(9): 1086-1095, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31039443

RESUMO

BACKGROUND: Microbial whole genome sequencing (WGS) has many advantages over standard microbiological methods. However, it is not yet widely implemented in routine hospital diagnostics due to notable challenges. OBJECTIVES: The aim was to extract managerial, financial and clinical criteria supporting the decision to implement WGS in routine diagnostic microbiology, across different operational models of implementation in the hospital setting. METHODS: This was a systematic review of literature identified through PubMed and Web of Science. English literature studies discussing the applications of microbial WGS without limitation on publication date were eligible. A narrative approach for categorization and synthesis of the sources identified was adopted. RESULTS: A total of 98 sources were included. Four main alternative operational models for incorporating WGS in clinical microbiology laboratories were identified: full in-house sequencing and analysis, full outsourcing of sequencing and analysis and two hybrid models combining in-house/outsourcing of the sequencing and analysis components. Six main criteria (and multiple related sub-criteria) for WGS implementation emerged from our review and included cost (e.g. the availability of resources for capital and operational investment); manpower (e.g. the ability to provide training programmes or recruit trained personnel), laboratory infrastructure (e.g. the availability of supplies and consumables or sequencing platforms), bioinformatics requirements (e.g. the availability of valid analysis tools); computational infrastructure (e.g. the availability of storage space or data safety arrangements); and quality control (e.g. the existence of standardized procedures). CONCLUSIONS: The decision to incorporate WGS in routine diagnostics involves multiple, sometimes competing, criteria and sub-criteria. Mapping these criteria systematically is an essential stage in developing policies for adoption of this technology, e.g. using a multicriteria decision tool. Future research that will prioritize criteria and sub-criteria that were identified in our review in the context of operational models will inform decision-making at clinical and managerial levels with respect to effective implementation of WGS for routine use. Beyond WGS, similar decision-making challenges are expected with respect to future integration of clinical metagenomics.


Assuntos
Doenças Transmissíveis/diagnóstico , Testes Diagnósticos de Rotina/normas , Técnicas Microbiológicas/normas , Sequenciamento Completo do Genoma/normas , Técnicas de Apoio para a Decisão , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/instrumentação , Humanos , Metagenômica , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/instrumentação , Controle de Qualidade , Sequenciamento Completo do Genoma/economia , Sequenciamento Completo do Genoma/instrumentação
3.
J Biosci Bioeng ; 127(4): 458-464, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30862359

RESUMO

Enthusiasm for mining isoprenoid-based flavors, pharmaceuticals, and nutraceuticals from GRAS (Generally Regarded as Safe) status microbial hosts has increased in the past few years due to the limitations associated with their plant-based extraction and chemical synthesis. Bacillus subtilis, a well-known GRAS microbe, is a promising alternative due to its fast growth rate and the ability to metabolize complex carbon sources. The study focused on the high-specificity production of isopentenol in B. subtilis by modulating the culture medium. Media modulation led to a 2.5 folds improvement in isopentenol titer in the wild-type strain. In the recombinant strain, optimization of physico-chemical factors, coupled with overexpression of the nudF enzyme resulted in a maximum isopentenol titer of ∼6 mg/L in a shake flask. The recombinant strain produced ∼5 mg/L isoprenol (∼80% of the total isopentenol production) and ∼1.8 mg/L prenol (∼65% of the total isopentenol production) by utilizing sorbitol and pyruvate as the carbon sources, respectively. Replacement of glucose with sorbitol and pyruvate reduced the production of the undesired metabolites and enhanced high-specificity production of isopentenol. Upon replacement of the carbon source with a low-cost substrate, a non-detoxified rice-straw hydrolysate, the engineered strain produced 2.19 mg/L isopentenol. This proof-of-concept study paves the path for the high-specificity production and cost-effective recovery of isopentenol from industrially competent microbial strains with engineered isoprenoid pathways.


Assuntos
Bacillus subtilis/efeitos dos fármacos , Bacillus subtilis/metabolismo , Meios de Cultura/farmacologia , Técnicas Microbiológicas/métodos , Pentanóis/metabolismo , Bacillus subtilis/genética , Técnicas de Cultura Celular por Lotes/economia , Técnicas de Cultura Celular por Lotes/métodos , Biomassa , Análise Custo-Benefício , Meios de Cultura/química , Engenharia Metabólica/economia , Engenharia Metabólica/métodos , Redes e Vias Metabólicas/efeitos dos fármacos , Redes e Vias Metabólicas/genética , Técnicas Microbiológicas/economia , Organismos Geneticamente Modificados , Oryza , Ácido Pirúvico/metabolismo
4.
J Appl Microbiol ; 126(6): 1944-1954, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30884047

RESUMO

AIMS: To evaluate a low-cost water quality test for at-scale drinking water safety estimation in rural India. METHODS AND RESULTS: Within a longitudinal study to characterize variability in household drinking water safety in rural Maharashtra, we piloted a low-cost presence-absence (LCPA) microbial test designed to be used by volunteer residents in rural areas. In comparing the LCPA results with standard laboratory methods for enumeration of Escherichia coli, we found that LCPA tests using modified mTec media were highly sensitive in detecting drinking water of moderate risk (88% of tests were positive at E. coli counts of 11-100 CFU per 100 ml) and high risk (96% of tests were positive at E. coli counts of 101 + CFU per 100 ml). The LCPA tests demonstrated low specificity for E. coli specifically, due to concurrent detection of Klebsiella: 38% of LCPA tests were positive even when E. coli was not detected in a 100 ml sample by membrane filtration, suggesting the test would be conservative in risk estimation. We also found that 47% of participants in rural villages in India were willing to conduct tests and return results after a brief training, with 45% of active participants sending their water testing results via short message service. CONCLUSIONS: Given their low cost (~US$0.50 as piloted) and open-source format, such tests may provide a compelling alternative to standard methods for rapid water quality assessments, especially in resource-limited settings. SIGNIFICANCE AND IMPACT OF THE STUDY: The lack of availability of water quality data constrains efforts to monitor, evaluate and improve the safety of water and sanitation infrastructure in underserved settings. Current water testing methods are not scalable because of laboratory and cost constraints. Our findings indicate the LCPA or similar low-cost microbial tests could be useful in rapid water safety estimation, including via crowdsourcing.


Assuntos
Água Potável/microbiologia , Água Potável/normas , Monitoramento Ambiental/métodos , Técnicas Microbiológicas/métodos , Microbiologia da Água , Abastecimento de Água/normas , Contagem de Colônia Microbiana , Monitoramento Ambiental/economia , Monitoramento Ambiental/normas , Escherichia coli/crescimento & desenvolvimento , Humanos , Índia , Estudos Longitudinais , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/normas
5.
BMC Infect Dis ; 19(1): 93, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691448

RESUMO

BACKGROUND: Tuberculosis is a major challenge to health in the developing world. Triage prior to diagnostic testing could potentially reduce the volume of tests and costs associated with using the more accurate, but costly, Xpert MTB/RIF assay. An effective methodology to predict the impact of introducing triage prior to tuberculosis diagnostic testing could be useful in helping to guide policy. METHODS: The development and use of operational modelling to project the impact on case detection and health system costs of alternative triage approaches for tuberculosis, with or without X-ray, based on data from Porto Alegre City, Brazil. RESULTS: Most of the triage approaches modelled without X-ray were predicted to provide no significant benefit. One approach based on an artificial neural network applied to patient and symptom characteristics was projected to increase case detection (82% vs. 75%) compared to microscopy, and reduce costs compared to Xpert without triage. In addition, use of X-ray before diagnostic testing for HIV-negative patients could maintain diagnostic yield of using Xpert without triage, and reduce costs. CONCLUSION: A model for the impact assessment of alternative triage approaches has been tested. The results from using the approach demonstrate its usefulness in informing policy in a typical high burden setting for tuberculosis.


Assuntos
Técnicas de Apoio para a Decisão , Radiografia Torácica , Triagem/métodos , Tuberculose/diagnóstico , Algoritmos , Brasil/epidemiologia , Análise Custo-Benefício , Humanos , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Modelos Organizacionais , Mycobacterium tuberculosis/isolamento & purificação , Radiografia Torácica/economia , Sensibilidade e Especificidade , Escarro/microbiologia , Triagem/economia , Triagem/organização & administração , Tuberculose/economia , Tuberculose/epidemiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Raios X
7.
Int J Food Microbiol ; 282: 24-27, 2018 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-29885974

RESUMO

Advances in microbiological testing methods have led to faster and less expensive assays. Given these advances, it is logical to employ these assays for use in the sampling plan of an existing microbiological criterion. A change in the performance characteristics of the assay can affect the intended effect of the microbiological criterion. This study describes a method for updating a 2-class attributes sampling plan to account for the different test sensitivity and specificity of a new assay and provides an example based on the replacement of a culture-based assay with a real-time polymerase chain reaction assay.


Assuntos
Campylobacter/isolamento & purificação , Galinhas/microbiologia , Produtos da Carne/microbiologia , Técnicas Microbiológicas/métodos , Animais , Campylobacter/genética , Laboratórios , Técnicas Microbiológicas/economia , Reação em Cadeia da Polimerase em Tempo Real , Sensibilidade e Especificidade
8.
Sci Rep ; 8(1): 9055, 2018 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-29899430

RESUMO

A novel imaging-driven technique with an integrated fluorescence signature to enable automated enumeration of two species of cyanobacteria and an alga of somewhat similar morphology to one of the cyanobacteria is presented to demonstrate proof-of-concept that high accuracy, imaging-based, rapid water quality analysis can be with conventional equipment available in typical water quality laboratories-this is not currently available. The results presented herein demonstrate that the developed method identifies and enumerates cyanobacterial cells at a level equivalent to or better than that achieved using standard manual microscopic enumeration techniques, but in less time, and requiring significantly fewer resources. When compared with indirect measurement methods, the proposed method provides better accuracy at both low and high cell concentrations. It extends the detection range for cell enumeration while maintaining accuracy and increasing enumeration speed. The developed method not only accurately estimates cell concentrations, but it also reliably distinguishes between cells of Anabaena flos-aquae, Microcystis aeruginosa, and Ankistrodesmus in mixed cultures by taking advantage of additional contrast between the target cell and complex background gained under fluorescent light. Thus, the proposed image-driven approach offers promise as a robust and cost-effective tool for identifying and enumerating microscopic cells based on their unique morphological features.


Assuntos
Anabaena/citologia , Clorofíceas/citologia , Fluorescência , Microcystis/citologia , Anabaena/química , Anabaena/crescimento & desenvolvimento , Clorofíceas/química , Clorofíceas/crescimento & desenvolvimento , Análise Custo-Benefício , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Microcystis/química , Microcystis/crescimento & desenvolvimento , Reprodutibilidade dos Testes
9.
Microb Ecol ; 76(4): 851-855, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29623358

RESUMO

Over the past few decades, studies have demonstrated that the gut microbiota strongly influences the physiology, behavior, and fitness of its host. Such studies have been conducted primarily in humans and model organisms under controlled laboratory conditions. More recently, researchers have realized the importance of placing host-associated microbiota studies into a more ecological context; however, few non-destructive methods have been established to collect fecal samples from wild birds. Here, we present an inexpensive and easy-to-use kit for the non-invasive collection of feces from small birds. The portability of the collection kit makes this method amenable to field studies, especially those in remote areas. The main components of the collection kit include a flat-bottomed paper bag, a large modified weigh boat (tray), vinyl-coated hardware cloth fencing (grate), a clothespin, and a 10% bleach solution (to sterilize the tray and grate). In the paper bag, a sterile tray is placed under a small grate, which prevents the birds from contacting the feces and reduces the risk of contamination. After capture, the bird is placed in the bag for 3-5 min until it defecates. After the bird is removed from the bag, the tray is extracted and the fecal sample is moved to a collection tube and frozen or preserved. We believe that our method is an affordable and easy option for researchers studying the gut microbiota of wild birds.


Assuntos
Aves/microbiologia , Fezes/microbiologia , Microbioma Gastrointestinal , Técnicas Microbiológicas/métodos , Animais , Animais Selvagens/microbiologia , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/instrumentação
10.
BMC Infect Dis ; 18(1): 154, 2018 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-29609540

RESUMO

BACKGROUND: Implant-related infections, including those of peri-prosthetic joint (PJIs), osteosynthesis and other biomaterials, are biofilm-related. Pathogen identification is considered the diagnostic benchmark; however, the presence of bacterial biofilms makes pathogen detection with traditional microbiological techniques only partially effective. To improve microbiological diagnostic accuracy, some biofilm debonding techniques have been recently proposed. Aim of this health economics assessment study was to evaluate their economic impact on hospital costs. METHODS: Direct and indirect hospital costs connected with the routine introduction of sonication and dithiothreitol treatment applied to hip and knee PJIs and of tissue cultures were examined. In particular the consequences of diagnostic inaccuracy, the opportunities, costs, and risks of each technique were calculated. RESULTS: Considering an average of five samples per patient, processed separately with traditional tissue culture with or without sonication of prosthetic components, or pooled together using the MicroDTTect device (a close system for sample collection, transport and treatment with Dithiothreitol for microbial release from biofilm), the overall mean direct cost per patient was € 397 and € 393 for sonication or MicroDTTect, respectively, compared to € 308 for traditional tissue cultures. In terms of opportunity costs, MicroDTTect was the most effective technique, allowing for a 35% or 55% reduction in time required for sample treatment, compared to tissue cultures combined or not with sonication, respectively. Pooling together direct and indirect costs associated with false positive and negative results of the different diagnostic techniques, unnecessary medical treatments and possible medical claims, MicroDTTect or sonication become increasingly cost-effective when the extra-costs, generated by diagnostic inaccuracy of traditional tissue culture, took place, respectively, in 2% or 20% or more of the patients. CONCLUSIONS: This is the first study specifically focused on the economic impact of the routine clinical use of microbiological antibiofilm sampling and processing techniques in orthopaedics. Although our results may suffer from a potential country and hospital bias, as the data collection process for direct and indirect costs is specific to each institution and country, this analysis highlights the potential economic advantage to hospitals associated with the routine introduction of antibiofilm techniques for microbiological diagnosis of PJI.


Assuntos
Biofilmes , Prótese de Quadril/microbiologia , Prótese do Joelho/microbiologia , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Infecções Relacionadas à Prótese/diagnóstico , Algoritmos , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacos , Análise Custo-Benefício , Articulação do Quadril/microbiologia , Articulação do Quadril/patologia , Humanos , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/microbiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Manejo de Espécimes
11.
Pediatr Int ; 60(5): 423-427, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29468780

RESUMO

BACKGROUND: Routine catheter tip cultures are not recommended because some cases of colonization, such as with Staphylococcus aureus, can lead to subsequent bacteremia. To evaluate the safety of colonization without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. METHODS: We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 and noted outcome (i.e. antimicrobial treatment or subsequent infection). We then performed a cost analysis for routine catheter tip culturing on patients who were symptom free during the study period. RESULTS: Of the 93 positive cases in 80 patients from 1,051 catheter tip cultures, seven patients had suspected infection and were treated with antimicrobials. The other 73 symptom-free, positive patients had no subsequent or exacerbated symptoms indicative of an infection, and did not have antimicrobial treatment. The total cost for catheter tip culturing during the study period was ¥548 731. After excluding patients with symptoms of infection at the time of culture, the efficacy of routine catheter tip cultures on symptom-free patients was estimated to be zero. CONCLUSION: Symptom-free colonization did not affect clinician management in this study, and all colonized patients without suspected infection were safely managed without antimicrobials. Furthermore, routine catheter tip culturing was not cost-effective; therefore, this practice may be no longer recommended in the NICU.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Infecções Relacionadas a Cateter/economia , Custos e Análise de Custo , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Japão , Masculino , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Estudos Retrospectivos
12.
Clin Infect Dis ; 66(12): 1892-1898, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29293941

RESUMO

Background: Culture-independent diagnostic tests (CIDTs) are increasingly used to identify enteric pathogens. However, foodborne illness surveillance systems have relied upon culture confirmation to estimate disease burden and identify outbreaks through molecular subtyping. This study examined the impacts of CIDT and estimated costs for culture verification of Shigella, Salmonella, Shiga toxin-producing Escherichia coli (STEC), and Campylobacter at the Tennessee Department of Health Public Health Laboratory (PHL). Methods: This observational study included laboratory and epidemiological surveillance data collected between years 2013-2016 from patients with the reported enteric illness. We calculated pathogen recovery at PHL based on initial diagnostic test type reported at the clinical laboratory. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated with modified Poisson regression. Estimates of cost were calculated for pathogen recovery from CIDT-positive specimens compared to recovery from culture-derived isolates. Results: During the study period, PHL received 5553 specimens from clinical laboratories from patients with the enteric illness. Pathogen recovery was 57% (984/1713) from referred CIDT-positive stool specimens and 95% (3662/3840) from culture-derived isolates (PR, 0.61 [95% CI, .56-.66]). Pathogen recovery from CIDT-positive specimens varied based on pathogen type: Salmonella (72%), Shigella (64%), STEC (57%), and Campylobacter (26%). Compared to stool culture-derived isolates, the cost to recover pathogens from 100 CIDT-positive specimens was higher for Shigella (US $6192), Salmonella (US $18373), and STEC (US $27783). Conclusions: Pathogen recovery was low from CIDT-positive specimens for enteric bacteria. This has important implications for the current enteric disease surveillance system, outbreak detection, and costs for public health programs.


Assuntos
Técnicas de Laboratório Clínico/economia , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/isolamento & purificação , Técnicas Microbiológicas/economia , Adolescente , Adulto , Campylobacter/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/métodos , Enterobacteriaceae/patogenicidade , Monitoramento Epidemiológico , Fezes/microbiologia , Feminino , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Masculino , Técnicas Microbiológicas/métodos , Análise de Regressão , Estudos Retrospectivos , Salmonella/isolamento & purificação , Shigella/isolamento & purificação , Tennessee , Estados Unidos , United States Public Health Service/economia , Adulto Jovem
13.
J Clin Microbiol ; 56(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29093106

RESUMO

Conventional methods for the identification of gastrointestinal pathogens are time-consuming and expensive and have limited sensitivity. The aim of this study was to determine the clinical impact of a comprehensive molecular test, the BioFire FilmArray gastrointestinal (GI) panel, which tests for many of the most common agents of infectious diarrhea in approximately 1 h. Patients with stool cultures submitted were tested on the GI panel (n = 241) and were compared with control patients (n = 594) from the year prior. The most common organisms detected by the GI panel were enteropathogenic Escherichia coli (EPEC, n = 21), norovirus (n = 21), rotavirus (n = 15), sapovirus (n = 9), and Salmonella (n = 8). Patients tested on the GI panel had an average of 0.58 other infectious stool tests compared with 3.02 in the control group (P = 0.0001). The numbers of days on antibiotic(s) per patient were 1.73 in the cases and 2.12 in the controls (P = 0.06). Patients with the GI panel had 0.18 abdomen and/or pelvic imaging studies per patient compared with 0.39 (P = 0.0002) in the controls. The average length of time from stool culture collection to discharge was 3.4 days in the GI panel group versus 3.9 days in the controls (P = 0.04). The overall health care cost could have decreased by $293.61 per patient tested. The GI panel improved patient care by rapidly identifying a broad range of pathogens which may not have otherwise been detected, reducing the need for other diagnostic tests, reducing unnecessary use of antibiotics, and leading to a reduction in hospital length of stay.


Assuntos
Testes Diagnósticos de Rotina/economia , Gerenciamento Clínico , Gastroenterite/diagnóstico , Trato Gastrointestinal , Custos de Cuidados de Saúde/estatística & dados numéricos , Técnicas Microbiológicas/métodos , Reação em Cadeia da Polimerase , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/genética , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Diarreia/diagnóstico , Fezes/microbiologia , Fezes/virologia , Feminino , Florida , Gastroenterite/microbiologia , Gastroenterite/virologia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/normas , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/economia , Reação em Cadeia da Polimerase/normas , Centros de Atenção Terciária , Fatores de Tempo , Vírus/genética , Vírus/isolamento & purificação , Adulto Jovem
14.
J Cutan Med Surg ; 22(2): 129-141, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28954534

RESUMO

BACKGROUND: Onychomycosis can be investigated by sampling. Information gleaned includes nail bed involvement, nail plate penetration, fungal viability, and species identification. Testing samples can confirm a diagnosis. While diagnostic testing is considered useful in directing therapy, a substantial number of clinicians do not confirm diagnosis prior to treatment. OBJECTIVES: The aim of this study is to quantify the benefit of confirmatory testing prior to treating toenail onychomycosis. METHODS: The cost of mycological cure (negative potassium hydroxide and negative culture) and the cost-effectiveness of confirmatory testing were determined using the average cost of potassium hydroxide (KOH), culture, periodic acid-Schiff (PAS), efinaconazole, ciclopirox, terbinafine, and itraconazole. Costs were obtained through literature searches, public domain websites, and telephone surveys to local pharmacies and laboratories. To represent the potential risks of prescribing onychomycosis treatment, the costs associated with liver monitoring, potential life-threatening adverse events, and drug-drug interactions were obtained through public domain websites, published studies, and product inserts. RESULTS: PAS was determined to be the most sensitive confirmatory test and KOH the least expensive. The overall cost of an incorrect diagnosis (no confirmatory test used) ranged between $350 and $1175 CAD per patient for treatment of 3 infected toenails. Comparatively, performing confirmatory testing prior to treatment decreases the overall cost to $320 to $930, depending on the therapy, physician, and test. CONCLUSIONS: It is preferred to diagnose onychomycosis prior to treatment. Furthermore, there are cost savings when confirmatory testing is performed before initiating treatment with both topical and oral antifungals in Canada.


Assuntos
Antifúngicos/economia , Técnicas Microbiológicas , Onicomicose , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Humanos , Hidróxidos/economia , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Onicomicose/economia , Reação do Ácido Periódico de Schiff/economia , Compostos de Potássio/economia
15.
Intern Emerg Med ; 13(1): 69-73, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-27988829

RESUMO

Community-acquired pneumonia (CAP) is frequent and can be life-threatening. Streptococcus pneumoniae is the main bacteria involved, and is susceptible to penicillin A. Rapid microbiological diagnosis could then help reduce the antimicrobial spectrum. The pneumococcal urinary antigen (PUA) test is fast and easy to perform, but its impact on antimicrobial prescription and cost-effectiveness in emergency departments (ED) is not well known. We performed a pragmatic real life retrospective study in an adult ED to assess its usefulness: proportion of positive results, impact on antimicrobial prescriptions and cost-effectiveness. Over 3 years (from January 1st 2012 to December 31st 2014), 979 PUA tests were reutilized in our ED among 1224 patients who consulted for CAP; 51 (5.2%) were positive. Among them, 10 led to a modification of the antimicrobial treatment, but only 7 (14.3%) were in accordance with the results. The total cost of a PUA test is 27€. As only 7 PUA tests led to appropriate antimicrobial modification, we deemed that 972 had no impact, and the potential cost savings, if the test had not been used, would have been 26,244 € (972 × 27) during 3 years, that is 8748 € per year. Thus, it seems that the PUA test should not be generally used in the ED considering its low rate of positivity and the difficulties for physicians to adapt antibiotic treatment accordingly. This attitude change in utilization would lead to substantial cost savings.


Assuntos
Antígenos de Bactérias/análise , Análise Custo-Benefício/estatística & dados numéricos , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/urina , Streptococcus pneumoniae/metabolismo , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/economia , Antibacterianos/uso terapêutico , Antígenos de Bactérias/economia , Antígenos de Bactérias/metabolismo , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Pessoa de Meia-Idade , Infecções Pneumocócicas/imunologia , Estudos Retrospectivos , Streptococcus pneumoniae/patogenicidade
16.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(10): 659-666, dic. 2017. graf, tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-169567

RESUMO

La necesidad de reducir el tiempo de diagnóstico microbiológico y la irrupción de nuevas tecnologías relacionadas con la microbiología molecular y la proteómica han favorecido el desarrollo de técnicas rápidas y de realización en el lugar de asistencia al paciente (point-of-care), así como de los denominados laboratorios point-of-care, espacios que concentran la realización de ambas técnicas como respuesta, en parte, a la externalización de los laboratorios convencionales de los hospitales. Su introducción no siempre se ha acompañado de evaluaciones económicas (estudios de coste-efectividad, coste-beneficio y coste-utilidad) y suelen limitarse al precio unitario de la prueba. Este último, influido por el procedimiento de compra, no suele tener un valor de referencia regulado, como en el caso de los medicamentos. Los análisis de coste-efectividad que mayor repercusión han tenido han sido los realizados recientemente con la espectrometría de masas en el diagnóstico de la bacteriemia y el uso de antimicrobianos y pueden servir como modelo de futuros estudios económicos de las pruebas rápidas y point-of-care (AU)


The need to reduce the time it takes to establish a microbiological diagnosis and the emergence of new molecular microbiology and proteomic technologies has fuelled the development of rapid and point-of-care techniques, as well as the so-called point-of-care laboratories. These laboratories are responsible for conducting both techniques partially to response to the outsourcing of the conventional hospital laboratories. Their introduction has not always been accompanied with economic studies that address their cost-effectiveness, cost-benefit and cost-utility, but rather tend to be limited to the unit price of the test. The latter, influenced by the purchase procedure, does not usually have a regulated reference value in the same way that medicines do. The cost-effectiveness studies that have recently been conducted on mass spectrometry in the diagnosis of bacteraemia and the use of antimicrobials have had the greatest clinical impact and may act as a model for future economic studies on rapid and point-of-care tests (AU)


Assuntos
Humanos , Microbiologia/economia , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/métodos , Avaliação de Custo-Efetividade , Avaliação do Impacto na Saúde/economia , Análise Custo-Benefício/economia
17.
Enferm Infecc Microbiol Clin ; 35(10): 659-666, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29033026

RESUMO

The need to reduce the time it takes to establish a microbiological diagnosis and the emergence of new molecular microbiology and proteomic technologies has fuelled the development of rapid and point-of-care techniques, as well as the so-called point-of-care laboratories. These laboratories are responsible for conducting both techniques partially to response to the outsourcing of the conventional hospital laboratories. Their introduction has not always been accompanied with economic studies that address their cost-effectiveness, cost-benefit and cost-utility, but rather tend to be limited to the unit price of the test. The latter, influenced by the purchase procedure, does not usually have a regulated reference value in the same way that medicines do. The cost-effectiveness studies that have recently been conducted on mass spectrometry in the diagnosis of bacteraemia and the use of antimicrobials have had the greatest clinical impact and may act as a model for future economic studies on rapid and point-of-care tests.


Assuntos
Testes Diagnósticos de Rotina/economia , Técnicas Microbiológicas/economia , Sistemas Automatizados de Assistência Junto ao Leito/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , União Europeia , Previsões , Mortalidade Hospitalar , Hospitalização/economia , Humanos , Tempo de Internação/economia , Metanálise como Assunto , Sistemas Automatizados de Assistência Junto ao Leito/legislação & jurisprudência , Anos de Vida Ajustados por Qualidade de Vida , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Fatores de Tempo
18.
Medicine (Baltimore) ; 96(30): e7641, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28746227

RESUMO

We aimed to investigate the diagnostic yield of stool cultures and identify predictive factors for positive cultures in patients with diarrheal illness.A total of 13,327 patients who underwent stool cultures due to diarrheal illness were reviewed. Stool cultures were performed for enteric pathogens, including Salmonella, Shigella, Vibrio, Klebsiella oxytoca, and Yersinia. The culture-positive group was compared with the culture-negative group who were randomly selected from culture negative patients.A total of 196 patients (1.47%) were diagnosed with positive stool culture. In 196 culture positive patients, Salmonella spp. (75.0%) was detected most commonly, followed by Vibrio (19.4%). Univariate analyses showed fever (>37.8°C), vomiting, duration and frequency of diarrhea, and high C-reactive protein (CRP) were significantly associated with positive stool culture. Multivariate analysis showed fever (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.25-4.35; P = .008), ≥5/day of diarrhea (OR, 3.52; 95% CI, 1.93-6.44; P < .001) and >50 mg/L of CRP (OR, 2.27; 95% CI, 1.18-4.36; P = .014) were independent predictors for positive stool culture. OR in patients with all 3 factors was 6.55 (95% CI, 2.56-16.75; P < .001). Vomiting (OR, 0.32; 95% CI, 0.17-0.57; P < .001) was a negative predictive factor.Diagnostic yield of stool culture in patients with diarrheal illness is very low. Fever, frequency of diarrhea, and high CRP are predictors for positive stool cultures. These findings may lead to more discerning and cost-effective utilization of stool culture by clinicians.


Assuntos
Diarreia/microbiologia , Fezes/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diarreia/economia , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Técnicas Microbiológicas/economia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , República da Coreia , Estudos Retrospectivos , Adulto Jovem
19.
PLoS One ; 12(7): e0181923, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28746418

RESUMO

For various experimental applications, microbial cultures at defined, constant densities are highly advantageous over simple batch cultures. Due to high costs, however, devices for continuous culture at freely defined densities still experience limited use. We have developed a small-scale turbidostat for research purposes, which is manufactured from inexpensive components and 3D printed parts. A high degree of spatial system integration and a graphical user interface provide user-friendly operability. The used optical density feedback control allows for constant continuous culture at a wide range of densities and offers to vary culture volume and dilution rates without additional parametrization. Further, a recursive algorithm for on-line growth rate estimation has been implemented. The employed Kalman filtering approach based on a very general state model retains the flexibility of the used control type and can be easily adapted to other bioreactor designs. Within several minutes it can converge to robust, accurate growth rate estimates. This is particularly useful for directed evolution experiments or studies on metabolic challenges, as it allows direct monitoring of the population fitness.


Assuntos
Algoritmos , Escherichia coli/crescimento & desenvolvimento , Técnicas Microbiológicas/instrumentação , Técnicas Microbiológicas/métodos , Modelos Teóricos , Reatores Biológicos/microbiologia , Divisão Celular , Simulação por Computador , Análise Custo-Benefício , Escherichia coli/citologia , Técnicas Microbiológicas/economia , Reprodutibilidade dos Testes , Software , Fatores de Tempo
20.
Braz. j. microbiol ; 48(3): 515-521, July-Sept. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-889145

RESUMO

Abstract Ammonia-oxidizing bacteria were immobilized by polyvinyl alcohol (PVA) and sodium alginate. The immobilization conditions and ammonia oxidation ability of the immobilized bacteria were investigated. The following immobilization conditions were observed to be optimal: PVA, 12%; sodium alginate, 1.1%; calcium chloride, 1.0%; inoculum concentration, 1.3 immobilized balls/mL of immobilized medium; pH, 10; and temperature, 30 °C. The immobilized ammonia-oxidizing bacteria exhibited strong ammonia oxidation ability even after being recycled four times. The ammonia nitrogen removal rate of the immobilized ammonia-oxidizing bacteria reached 90.30% under the optimal immobilization conditions. When compared with ammonia-oxidizing bacteria immobilized by sodium alginate alone, the bacteria immobilized by PVA and sodium alginate were superior with respect to pH resistance, the number of reuses, material cost, heat resistance, and ammonia oxidation ability.


Assuntos
Bactérias/química , Técnicas Microbiológicas/métodos , Amônia/metabolismo , Oxirredução , Álcool de Polivinil/química , Temperatura Ambiente , Bactérias/metabolismo , Técnicas Microbiológicas/economia , Técnicas Microbiológicas/instrumentação , Células Imobilizadas/metabolismo , Células Imobilizadas/química , Ácido Glucurônico/química , Alginatos/química , Ácidos Hexurônicos/química , Concentração de Íons de Hidrogênio
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