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Gomila A, Carratalà J, Eliakim-Raz N, Shaw E, Wiegand I, Vallejo-Torres L, Gorostiza A, Vigo JM, Morris S, Stoddart M, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M. Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study. Infect Drug Resist 2018; 11:2571-2581. [PMID: 30588040 PMCID: PMC6302800 DOI: 10.2147/idr.s185753] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Complicated urinary tract infections (cUTIs) are among the most frequent health-care-associated infections. In patients with cUTI, Pseudomonas aeruginosa deserves special attention, since it can affect patients with serious underlying conditions. Our aim was to gain insight into the risk factors and prognosis of P. aeruginosa cUTIs in a scenario of increasing multidrug resistance (MDR). Methods This was a multinational, retrospective, observational study at 20 hospitals in south and southeastern Europe, Turkey, and Israel including consecutive patients with cUTI hospitalized between January 2013 and December 2014. A mixed-effect logistic regression model was performed to assess risk factors for P. aeruginosa and MDR P. aeruginosa cUTI. Results Of 1,007 episodes of cUTI, 97 (9.6%) were due to P. aeruginosa. Resistance rates of P. aeruginosa were: antipseudomonal cephalosporins 35 of 97 (36.1%), aminoglycosides 30 of 97 (30.9%), piperacillin-tazobactam 21 of 97 (21.6%), fluoroquinolones 43 of 97 (44.3%), and carbapenems 28 of 97 (28.8%). The MDR rate was 28 of 97 (28.8%). Independent risk factors for P. aeruginosa cUTI were male sex (OR 2.61, 95% CI 1.60-4.27), steroid therapy (OR 2.40, 95% CI 1.10-5.27), bedridden functional status (OR 1.79, 95% CI 0.99-3.25), antibiotic treatment within the previous 30 days (OR 2.34, 95% CI 1.38-3.94), indwelling urinary catheter (OR 2.41, 95% CI 1.43-4.08), and procedures that anatomically modified the urinary tract (OR 2.01, 95% CI 1.04-3.87). Independent risk factors for MDR P. aeruginosa cUTI were age (OR 0.96, 95% CI 0.93-0.99) and anatomical urinary tract modification (OR 4.75, 95% CI 1.06-21.26). Readmission was higher in P. aeruginosa cUTI patients than in other etiologies (23 of 97 [23.7%] vs 144 of 910 [15.8%], P=0.04), while 30-day mortality was not significantly different (seven of 97 [7.2%] vs 77 of 910 [8.5%], P=0.6). Conclusion Patients with P. aeruginosa cUTI had characteristically a serious baseline condition and manipulation of the urinary tract, although their mortality was not higher than that of patients with cUTI caused by other etiologies.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain, .,Infectious Diseases Department, University of Barcelona, Barcelona, Spain
| | - N Eliakim-Raz
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - E Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - I Wiegand
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - L Vallejo-Torres
- UCL Department of Applied Health Research, University College London, London, UK
| | - A Gorostiza
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
| | - J M Vigo
- Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain
| | - S Morris
- UCL Department of Applied Health Research, University College London, London, UK
| | - M Stoddart
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - S Grier
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - C Vank
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - N Cuperus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Van den Heuvel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C Vuong
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - A MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - L Leibovici
- Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - I Addy
- AiCuris Anti-infective Cures, Wuppertal, Germany
| | - M Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain, .,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
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Vallejo-Torres L, Melnychuk M, Vindrola-Padros C, Aitchison M, Clarke CS, Fulop NJ, Hines J, Levermore C, Maddineni SB, Perry C, Pritchard-Jones K, Ramsay AIG, Shackley DC, Morris S. Discrete-choice experiment to analyse preferences for centralizing specialist cancer surgery services. Br J Surg 2018; 105:587-596. [PMID: 29512137 PMCID: PMC5900867 DOI: 10.1002/bjs.10761] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022]
Abstract
Background Centralizing specialist cancer surgery services aims to reduce variations in quality of care and improve patient outcomes, but increases travel demands on patients and families. This study aimed to evaluate preferences of patients, health professionals and members of the public for the characteristics associated with centralization. Methods A discrete‐choice experiment was conducted, using paper and electronic surveys. Participants comprised: former and current patients (at any stage of treatment) with prostate, bladder, kidney or oesophagogastric cancer who previously participated in the National Cancer Patient Experience Survey; health professionals with experience of cancer care (11 types including surgeons, nurses and oncologists); and members of the public. Choice scenarios were based on the following attributes: travel time to hospital, risk of serious complications, risk of death, annual number of operations at the centre, access to a specialist multidisciplinary team (MDT) and specialist surgeon cover after surgery. Results Responses were obtained from 444 individuals (206 patients, 111 health professionals and 127 members of the public). The response rate was 52·8 per cent for the patient sample; it was unknown for the other groups as the survey was distributed via multiple overlapping methods. Preferences were particularly influenced by risk of complications, risk of death and access to a specialist MDT. Participants were willing to travel, on average, 75 min longer in order to reduce their risk of complications by 1 per cent, and over 5 h longer to reduce risk of death by 1 per cent. Findings were similar across groups. Conclusion Respondents' preferences in this selected sample were consistent with centralization. Most favour it
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Affiliation(s)
- L Vallejo-Torres
- Department of Applied Health Research, University College London, London, UK.,Department of Quantitative Methods in Economics and Management, University of Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - M Melnychuk
- Department of Applied Health Research, University College London, London, UK
| | - C Vindrola-Padros
- Department of Applied Health Research, University College London, London, UK
| | - M Aitchison
- Department of Renal and Nephrology Services, Royal Free London NHS Foundation Trust, London, UK
| | - C S Clarke
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - J Hines
- Urology Department, University College London Hospital, London, UK
| | - C Levermore
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK
| | - S B Maddineni
- Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
| | - C Perry
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - K Pritchard-Jones
- University College London Hospitals Cancer Collaborative, University College London Hospitals NHS Foundation Trust, London, UK.,Academic Health Science Network Cancer Programme, University College London Partners, London, UK
| | - A I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | - D C Shackley
- Greater Manchester Cancer, hosted by Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - S Morris
- Department of Applied Health Research, University College London, London, UK
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Vallejo-Torres L, Castilla I, González N, Hunter R, Serrano-Pérez P, Perestelo-Pérez L. Cost-effectiveness of electroconvulsive therapy compared to repetitive transcranial magnetic stimulation for treatment-resistant severe depression: a decision model. Psychol Med 2015; 45:1459-1470. [PMID: 25354790 PMCID: PMC4413854 DOI: 10.1017/s0033291714002554] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/04/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is widely applied to treat severe depression resistant to standard treatment. Results from previous studies comparing the cost-effectiveness of this technique with treatment alternatives such as repetitive transcranial magnetic stimulation (rTMS) are conflicting. METHOD We conducted a cost-effectiveness analysis comparing ECT alone, rTMS alone and rTMS followed by ECT when rTMS fails under the perspective of the Spanish National Health Service. The analysis is based on a Markov model which simulates the costs and health outcomes of individuals treated under these alternatives over a 12-month period. Data to populate this model were extracted and synthesized from a series of randomized controlled trials and other studies that have compared these techniques on the patient group of interest. We measure effectiveness using quality-adjusted life years (QALYs) and characterize the uncertainty using probabilistic sensitivity analyses. RESULTS ECT alone was found to be less costly and more effective than rTMS alone, while the strategy of providing rTMS followed by ECT when rTMS fails is the most expensive and effective option. The incremental cost per QALY gained of this latter strategy was found to be above the reference willingness-to-pay threshold used in these types of studies in Spain and other countries. The probability that ECT alone is the most cost-effective alternative was estimated to be around 70%. CONCLUSIONS ECT is likely to be the most cost-effective option in the treatment of resistant severe depression for a willingness to pay of €30,000 per QALY.
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Affiliation(s)
- L. Vallejo-Torres
- Departamento de Economía de las Instituciones, Estadística Económica y Econometría, Universidad de la Laguna, Spain
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - I. Castilla
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
- Fundación Canaria de Investigación y Salud (FUNCIS), Spain
| | - N. González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Research Unit Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - R. Hunter
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - L. Perestelo-Pérez
- Centro de Investigaciones Biomédicas de Canarias (CIBICAN), Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
- Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
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Karlsen S, Morris S, Kinra S, Vallejo-Torres L, Viner RM. Ethnic variations in overweight and obesity among children over time: findings from analyses of the Health Surveys for England 1998-2009. Pediatr Obes 2014; 9:186-96. [PMID: 23554401 PMCID: PMC4171811 DOI: 10.1111/j.2047-6310.2013.00159.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 02/09/2013] [Accepted: 02/11/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The increase in the prevalence of obesity among children and adolescents in England since the mid-1990s has been dramatic. Cross-sectional evidence suggests ethnic variations in childhood obesity prevalence. OBJECTIVES The objective of the study was to examine whether and how ethnic variations in childhood overweight/obesity have changed over time, and are affected by socioeconomic factors. METHOD This study uses logistic regression to analyse ethnic differences in the relative likelihood of being at or above the age- and gender-specific thresholds for overweight and obesity developed by the International Obesity Task Force among children aged between 2 and 15 from 11 ethnic groups included in the Health Surveys for England between 1998 and 2009, adjusting for age, gender, year of data collection and equivalized household income. We separately analyse the likelihood of being at or above the thresholds for overweight (but below those for obesity) and obesity. RESULTS Trends in overweight/obesity over time among ethnic minority groups do not follow those of white English children. Black African children had higher rates of overweight and obesity, which appear to have peaked, and black Caribbean children had higher rates of obesity than other groups examined, which appear to continue rising. These differences were not explained by socioeconomic variations between groups. CONCLUSION Policies are required that encourage healthy lifestyles among ethnic minority young people, while engaging with the complexities associated with these choices during childhood and adolescence.
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Affiliation(s)
- S Karlsen
- Department of Applied Health Research, University College LondonLondon, UK
| | - S Morris
- Department of Applied Health Research, University College LondonLondon, UK
| | - S Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineLondon, UK
| | | | - R M Viner
- Institute of Child Health, University College LondonLondon, UK
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