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Parienti J, Lucet J, Lefort A, Armand-Lefèvre L, Wolff M, Caron F, Cattoir V, Yazdanpanah Y. Empirical therapies among adults hospitalized for community-acquired upper urinary tract infections: A decision-tree analysis of mortality, costs, and resistance. Am J Infect Control 2015; 43:e53-9. [PMID: 26159501 DOI: 10.1016/j.ajic.2015.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Poor outcomes occur when patients with serious infections receive antibiotics to which the organisms are resistant. METHODS Decision trees simulated in-hospital mortality, costs, incremental cost-effectiveness ratio per life year saved, and carbapenem resistance according to 3 empirical antibiotic strategies among adults hospitalized for community-acquired (CA) upper urinary tract infections (UTIs): ceftriaxone (CRO) plus gentamicin (GM) in the intensive care unit (ICU), imipenem (IMP), and individualized choice (IMP or CRO) based on clinical risk factors for CA- extended-spectrum β-lactamase (ESBL). RESULTS The estimated prevalence of CA-ESBL on admission was 5% (range, 1.3%-17.6%); 3% and 97% were admitted to the ICU and medical ward (MW), respectively. In the ICU, CRO plus GM was dominated; IMP was cost-effective (incremental cost-effectiveness ratio: €4,400 per life year saved compared with individualized choice). In the MW, IMP had no impact on mortality and was less costly (-€142 per patient vs CRO, -€38 vs individualized choice). The dominance of IMP was consistent in sensitivity analyses. Compared with CRO, colonization by carbapenem-resistant pathogens increased by an odds ratio of 4.5 in the IMP strategy. CONCLUSION Among the ICU patients, empirical IMP therapy reduces mortality at an acceptable cost. Among MW patients, individualized choice or CRO is preferred to limit carbapenem resistance at a reasonable cost.
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Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii. Int J Infect Dis 2015; 38:32-5. [PMID: 26129972 DOI: 10.1016/j.ijid.2015.06.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/15/2015] [Accepted: 06/20/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A. baumannii is an important nosocomial pathogen associated with high mortality, morbidity and medical cost. AIM The aim of this study was to investigate risk factors for MDR A. baumannii bacteremia and also evaluate cost of hospitalization of these patients. METHODS Study was conducted in Ankara Atatürk Training and Research Hospital. Patients who were hospitalized in ICU and diagnosed for nosocomial blood stream infection (BSI) between January 2007 and December 2010 were checked retrospectively. Patients with nosocomial BSI caused by multidrug resistant A. baumannii were compared with the patients who had BSI caused by other Gram-negative microorganisms in terms of risk factors, mortality and medical costs. FINDINGS In multivariate analysis previous use of carbapenem, quinolone and metronidazole, and SAPS II score were found as independent risk factors. In case group; immunosupression, SAPS II score, and hospital stay until infection were independently associated with mortality in multivariate analysis. CONCLUSION Our results suggest that the occurrence of MDR A.baumannii bacteremia was related with the usage of the wide spectrum antibiotics, and mortality rates were increased in patients that high SAPS II scores, long term hospitalization. Infection control procedures and limited antibiotic usage are very important for prevent nosocomial infections.
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Rushton J. Anti-microbial Use in Animals: How to Assess the Trade-offs. Zoonoses Public Health 2015; 62 Suppl 1:10-21. [PMID: 25903492 PMCID: PMC4440385 DOI: 10.1111/zph.12193] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Indexed: 11/30/2022]
Abstract
Antimicrobials are widely used in preventive and curative medicine in animals. Benefits from curative use are clear - it allows sick animals to be healthy with a gain in human welfare. The case for preventive use of antimicrobials is less clear cut with debates on the value of antimicrobials as growth promoters in the intensive livestock industries. The possible benefits from the use of antimicrobials need to be balanced against their cost and the increased risk of emergence of resistance due to their use in animals. The study examines the importance of animals in society and how the role and management of animals is changing including the use of antimicrobials. It proposes an economic framework to assess the trade-offs of anti-microbial use and examines the current level of data collection and analysis of these trade-offs. An exploratory review identifies a number of weaknesses. Rarely are we consistent in the frameworks applied to the economic assessment anti-microbial use in animals, which may well be due to gaps in data or the prejudices of the analysts. There is a need for more careful data collection that would allow information on (i) which species and production systems antimicrobials are used in, (ii) what active substance of antimicrobials and the application method and (iii) what dosage rates. The species need to include companion animals as well as the farmed animals as it is still not known how important direct versus indirect spread of resistance to humans is. In addition, research is needed on pricing antimicrobials used in animals to ensure that prices reflect production and marketing costs, the fixed costs of anti-microbial development and the externalities of resistance emergence. Overall, much work is needed to provide greater guidance to policy, and such work should be informed by rigorous data collection and analysis systems.
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Affiliation(s)
- J Rushton
- Veterinary Epidemiology Economics and Public Health Group, Production and Population Health Department, Royal Veterinary College, Hatfield, UK
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Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Peterson LE, Musser JM. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia. J Infect 2014; 69:216-25. [DOI: 10.1016/j.jinf.2014.05.005] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/09/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
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Das S, Harazin M, Wright MO, Dusich I, Robicsek A, Peterson LR. Active Surveillance and Decolonization Without Isolation Is Effective in Preventing Methicillin-Resistant Staphylococcus aureus Transmission in the Psychiatry Units. Open Forum Infect Dis 2014; 1:ofu067. [PMID: 25734137 PMCID: PMC4281815 DOI: 10.1093/ofid/ofu067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/15/2014] [Indexed: 11/23/2022] Open
Abstract
Background Control of methicillin-resistant Staphylococcus aureus (MRSA) is difficult in select populations. We used molecular typing to study the effect of universal surveillance and decolonization of carriers, without isolation, on MRSA transmission in a specialized unit. Methods Patients admitted to the unit were screened for nasal MRSA at admission and discharge. Those who acquired MRSA during their stay were identified and linked to carriers with shared time in unit. Molecular typing of isolates was performed to identify transmission. Results Of 3285 admissions, 82% were tested for MRSA nasal carriage; the discharge screening compliance was 64.7%. Admission prevalence was 2.3% among patients screened, and 7 (0.42%) acquired nasal MRSA during their stay. All patients who acquired MRSA shared time in the unit with a colonized patient. There were 3.9 MRSA acquisitions per 1000 at-risk days. Isolates from 5 patients that acquired MRSA during their stay as well as their potential donors (11 donor: recipient patient pairs) were available for typing. Pulsed-field gel electrophoresis matched 1 acquisition isolate to a colonized patient isolate. There were no MRSA infections during the study period. Conclusions Despite less than perfect nasal screening compliance and exemption from traditional isolation precautions, acquisition of MRSA was 0.42% in this patient population over a course of 4.75 years, including a single case of acquisition, genetically similar to a known potential donor source. Screening for MRSA colonization and decolonizing of carriers was sufficient in reducing transmission in this vulnerable population.
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Affiliation(s)
| | - Maureen Harazin
- Department of Laboratory Medicine and Pathology, Division of Microbiology , NorthShore University HealthSystem , Evanston, Illinois
| | | | - Irene Dusich
- Department of Laboratory Medicine and Pathology, Division of Microbiology , NorthShore University HealthSystem , Evanston, Illinois
| | - Ari Robicsek
- Department of Infection Control ; Pritzker School of Medicine , University of Chicago , Illinois
| | - Lance R Peterson
- Department of Infection Control ; Department of Laboratory Medicine and Pathology, Division of Microbiology , NorthShore University HealthSystem , Evanston, Illinois ; Pritzker School of Medicine , University of Chicago , Illinois
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Daroukh A, Delaunay C, Bigot S, Ceci JM, Siddhoun N, Bukreyeva I, Raisin J, Porcheret H, Maisonneuve L, Bouldouyre MA. Characteristics and costs of carbapenemase-producing enterobacteria carriers (2012/2013). Med Mal Infect 2014; 44:321-6. [PMID: 25022890 DOI: 10.1016/j.medmal.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/25/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- A Daroukh
- Unité d'hygiène et d'épidémiologie, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - C Delaunay
- Analyse de gestion, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - S Bigot
- Direction des ressources humaines, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - J M Ceci
- Département d'informatique médicale, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - N Siddhoun
- Analyse de gestion, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - I Bukreyeva
- Service de médecine interne et maladies infectieuses, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - J Raisin
- Unité d'hygiène et d'épidémiologie, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - H Porcheret
- Biologie médicale, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - L Maisonneuve
- Biologie médicale, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France
| | - M A Bouldouyre
- Service de médecine interne et maladies infectieuses, centre hospitalier intercommunal Robert-Ballanger, 93603 Aulnay-sous-Bois, France.
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Lupión C, López-Cortés LE, Rodríguez-Baño J. [Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand hygiene]. Enferm Infecc Microbiol Clin 2014; 32:603-9. [PMID: 24661995 DOI: 10.1016/j.eimc.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 12/12/2022]
Abstract
Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.
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Affiliation(s)
- Carmen Lupión
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España; Departamento de Enfermería, Universidad de Sevilla, Sevilla, España.
| | - Luis Eduardo López-Cortés
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España
| | - Jesús Rodríguez-Baño
- Unidad de Gestión Clínica Intercentro de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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Tansarli GS, Poulikakos P, Kapaskelis A, Falagas ME. Proportion of extended-spectrum -lactamase (ESBL)-producing isolates among Enterobacteriaceae in Africa: evaluation of the evidence--systematic review. J Antimicrob Chemother 2014; 69:1177-84. [DOI: 10.1093/jac/dkt500] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Thomson KS. Lowering of third generation cephalosporin breakpoints. Clin Infect Dis 2013; 57:1663-4. [PMID: 24006448 DOI: 10.1093/cid/cit569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kenneth S Thomson
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, Nebraska
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Lemos EV, de la Hoz FP, Alvis N, Einarson TR, Quevedo E, Castañeda C, Leon Y, Amado C, Cañon O, Kawai K. Impact of carbapenem resistance on clinical and economic outcomes among patients with Acinetobacter baumannii infection in Colombia. Clin Microbiol Infect 2013; 20:174-80. [PMID: 23668595 DOI: 10.1111/1469-0691.12251] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/15/2013] [Accepted: 04/20/2013] [Indexed: 11/28/2022]
Abstract
Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.
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Affiliation(s)
- E V Lemos
- Doctorado Interfacultades en Salud Publica, Universidad Nacional de Colombia, Bogota Cundinamarca, Colombia; Fundación para el desarrollo y apoyo en salud internacional, (FUDASAI), Bogota, Colombia
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