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Williams TJ, Moy N, Kaazan P, Callaghan G, Holtmann G, Martin N. Cost-effectiveness of taurolidine-citrate in a cohort of patients with intestinal failure receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr 2024; 48:165-173. [PMID: 38062902 DOI: 10.1002/jpen.2589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) in patients receiving home parenteral nutrition (HPN) for chronic intestinal failure (CIF) are associated with significant morbidity and financial costs. Taurolidine is associated with a reduction in bloodstream infections, with limited information on the cost-effectiveness as the primary prevention. This study aimed to determine the cost-effectiveness of using taurolidine-citrate for the primary prevention of CRBSIs within a quaternary hospital. METHODS All patients with CIF receiving HPN were identified between January 2015 and November 2022. Data were retrospectively collected regarding patient demographics, HPN use, CRBSI diagnosis, and use of taurolidine-citrate. The direct costs associated with CRBSI-associated admissions and taurolidine-citrate use were obtained from the coding department using a bottom-up approach. An incremental cost-effective analysis was performed, with a time horizon of 4 years, to compare the costs associated with primary and secondary prevention against the outcome of cost per infection avoided. RESULTS Forty-four patients received HPN within this period. The CRBSI rates were 3.25 infections per 1000 catheter days before the use of taurolidine-citrate and 0.35 infections per 1000 catheter days after taurolidine-citrate use. The incremental cost-effectiveness ratio indicates primary prevention is the weakly dominant intervention, with the base case value of $27.04 per CRBSI avoided. This held with one-way sensitivity analysis. CONCLUSION Taurolidine-citrate in the primary prevention of CRBSIs in patients with CIF receiving HPN is associated with reduced hospital costs and infection rates.
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Affiliation(s)
- Thomas J Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Naomi Moy
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Patricia Kaazan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Gavin Callaghan
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Neal Martin
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
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Zhang Y, Wang Y, Sheng Z, Wang Q, Shi D, Xu S, Ai Y, Chen E, Xu Y. Incidence Rate, Pathogens and Economic Burden of Catheter-Related Bloodstream Infection: A Single-Center, Retrospective Case-Control Study. Infect Drug Resist 2023; 16:3551-3560. [PMID: 37305736 PMCID: PMC10256568 DOI: 10.2147/idr.s406681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose Indwelling central venous catheters (CVCs) can cause catheter related bloodstream infection (CRBSI). CRBSI occurring in intensive care unit (ICU) patients may lead to the worse outcomes and extra medical costs. The present study aimed to assess the incidence and incidence density, pathogens and economic burden of CRBSI in ICU patients. Patients and Methods A case-control study was retrospectively carried out in six ICUs of one hospital between July 2013 and June 2018. The Department of Infection Control performed routinely surveillance for CRBSI on these different ICUs. Data of the clinical and microbiological characteristics of patients with CRBSI, the incidence and incidence density of CRBSI in ICUs, the attributable length of stay (LOS), and the costs among patients with CRBSI in ICU were collected and assessed. Results A total of 82 ICU patients with CRBSI were included into the study. The CRBSI incidence density was 1.27 per 1000 CVC-days in all ICUs, in which the highest was 3.52 per 1000 CVC-days in hematology ICU and the lowest was 0.14 per 1000 CVC-days in Special Procurement ICU. The most common pathogen causing CRBSI was Klebsiella pneumoniae (15/82, 16.67%), in which 12 (80%) were carbapenem resistant. Fifty-one patients were successfully matched with control patients. The average costs in the CRBSI group were $ 67,923, which were significantly higher (P < 0.001) than the average costs in the control group. The total average costs attributable to CRBSI were $33, 696. Conclusion The medical costs of ICU patients were closely related to the incidence of CRBSI. Imperative measures are needed to reduce CRBSI in ICU patients.
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Affiliation(s)
- Yibo Zhang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yichen Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Zike Sheng
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qun Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Dake Shi
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Shirui Xu
- Department of Clinical Laboratory Medicine, Shanghai Fenglin Clinical Laboratory Co. Ltd, Shanghai, People’s Republic of China
| | - Yaping Ai
- Health Economics and Outcome Research, Becton & Dickinson Medical Device (Shanghai) Ltd, Shanghai, People’s Republic of China
| | - Erzhen Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yumin Xu
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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Zhang X, Qin D, Liu G, Li F, Peng J, Xiang Y. Risk factors of nosocomial infection in patients underwent artificial liver support system: a retrospective case-control study. Eur J Gastroenterol Hepatol 2023; 35:604-608. [PMID: 36966761 DOI: 10.1097/meg.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Although nosocomial infection is one of the most discussed problems in patients undergoing artificial liver support system (ALSS) treatment, only few solutions have been proposed so far. This study aimed to explore the risk factors of nosocomial infection in patients treated with ALSS in order to aid in the development of future preventive measures. METHODS This retrospective case-control study included patients treated with ALSS at the Department of Infectious Diseases, First Affiliated Hospital of xxx Medical University between January 2016 and December 2021. RESULTS One hundred seventy-four patients were included. There were 57 patients in the nosocomial infection group and 117 patients in the non-nosocomial infection group, of them 127 males (72.99%) and 47 females (27.01%) with an average age of 48.15 ± 14.19 years old. Multivariate logistic regression analysis revealed that total bilirubin [odds ratio (OR) = 1.004; 95% confidence interval (CI), 1.001-1.007; P = 0.020], number of invasive procedures (OR = 2.161; 95% CI, 1.500-3.313; P < 0.001), blood transfusion (OR = 2.526; 95% CI, 1.312-4.864; P = 0.006) were independent risk factors and haemoglobin (Hb) (OR = 0.973; 95% CI, 0.953-0.994; P = 0.011) was a protective factor for nosocomial infection in patients treated with ALSS. CONCLUSION The total bilirubin, transfusion of blood products and higher number of invasive operations were independent risk factors for nosocomial infection in patients treated with ALSS, while higher Hb was a protective factor.
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Affiliation(s)
| | - Deyu Qin
- Department of Infectious Disease
| | | | | | - Jingjing Peng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University
| | - Yanling Xiang
- Department of Surgery and Anesthesiology, University-Town Hospital of Chongqing Medical University, Chongqing, China
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许 燕, 商 祯, Robert M. D, 施 丽. Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:141-146. [PMID: 35209978 PMCID: PMC8884050 DOI: 10.7499/j.issn.1008-8830.2109147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI. METHODS A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates. RESULTS A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05). CONCLUSIONS CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.
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Iyer K, Nisenholtz M, Gutierrez D, Winkler M, Tappenden K, Seidner D, Kirby DF, Spangenburg M, Potts R, Bonagura A, Bishop J, Metzger L, Arora S. Disseminating Knowledge in Intestinal Failure: Initial Report of the Learn Intestinal Failure Tele-ECHO (LIFT-ECHO) Project. JPEN J Parenter Enteral Nutr 2021; 45:1108-1112. [PMID: 33533531 DOI: 10.1002/jpen.2078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intestinal failure (IF) is defined as an ultrarare disease, with an estimated prevalence of ∼25,000 cases in the US. There is a suspicion of disparities in outcomes in IF care, likely related to widespread lack of expertise. The Extension for Community Healthcare Outcomes (ECHO) model originally described by Dr Sanjeev Arora has been used to disseminate knowledge and best practices in many chronic diseases to improve outcomes. We examined our initial experience with using the ECHO model to disseminate learning in IF. METHOD This is a retrospective review of the launch, growth, and geographic reach of the Learn Intestinal Failure TeleECHO (LIFT-ECHO) program using prospectively collected data. RESULTS The LIFT-ECHO program has achieved significant geographic reach and clinician engagement. The program has reached close to two-thirds of the states in the US and several countries outside. Clinician engagement in the learning program appears to be growing exponentially. CONCLUSION It is feasible to use the ECHO model to disseminate knowledge in managing a rare disease like IF while maintaining fidelity to the proven model. Studies are underway to demonstrate direct benefit to patients.
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Affiliation(s)
- Kishore Iyer
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - Marjorie Nisenholtz
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - David Gutierrez
- Mount Sinai School of Medicine, Intestinal Rehab and Transplant Program, New York, New York, USA
| | - Marion Winkler
- Department of Surgery and Nutritional Support Service, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kelly Tappenden
- Kinesiology and Nutrition, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Douglas Seidner
- Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michelle Spangenburg
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | | | | | | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico, Albuquerque, New Mexico, USA
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Abad-Segura E, González-Zamar MD, Gómez-Galán J, Bernal-Bravo C. Management Accounting for Healthy Nutrition Education: Meta-Analysis. Nutrients 2020; 12:E3715. [PMID: 33271836 PMCID: PMC7761494 DOI: 10.3390/nu12123715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 02/07/2023] Open
Abstract
Unequal economic growth shapes food systems. Nutrition problems incorporate inappropriate practices, so nutrition education is key to empowering consumers to choose healthy foods. However, increasing the accessibility of healthy diets is related to reducing the cost of nutritious foods. The accounting management of healthy nutrition should allow for optimal global decision-making. The evolution of scientific production and global research trends on this topic between 1968 and 2019 have been studied. Statistical and mathematical methods have been applied to 1738 documents from the Scopus database. The results provided data on the agents that participate in the development of the theme. Data reveal an exponential trend, especially in the previous decade, with more than 50% of scientific production. Future lines of research have been identified: investment in health systems; green label education; early impact of food insecurity; WIC (Women, Infants, and Children) nutrition education; food waste audit; and ecological footprint of food. The central contribution of the study has been to detect the main future directions of research, providing critical points that will allow us to identify the themes of future publications, in addition to providing an instrument for decision-making carried out by the research funding sponsors.
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Affiliation(s)
- Emilio Abad-Segura
- Department of Economics and Business, University of Almeria, 04120 Almeria, Spain
| | | | - José Gómez-Galán
- Department of Education, University of Extremadura, Avda. de Elvas s/n, 06006 Badajoz, Spain;
- Cupey Campus, College of Education, Ana G. Méndez University, San Juan, PR 00926, USA
| | - César Bernal-Bravo
- Department of Education Sciences, Language, Culture and Arts, Rey Juan Carlos University, Paseo Artilleros s/n, 28032 Madrid, Spain;
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