Prediction models for diagnosis and prognosis of the colonization or infection of multidrug-resistant organisms in adults: a systematic review, critical appraisal, and meta-analysis

Cost-benefit analysis of pharmacist early active consultation in patients with multidrug-resistant bacteria in China

BACKGROUND

Although Pharmacist Early Active Consultation (PEAC) has demonstrated clinical benefits in patients with multidrug-resistant organisms (MDROs), its cost-effectiveness in China remains insufficiently studied.

AIM

This study aimed to evaluate the cost-effectiveness of PEAC in patients with MDROs from the perspective of the Chinese healthcare system.

METHOD

A historically controlled study was conducted on 100 MDRO-infected patients, including 37 who received PEAC and 63 who did not. The effective treatment rate and duration of the symptoms were assessed. A decision tree model was developed using model inputs derived from the study. The primary endpoints included incremental cost per MDRO treatment and incremental cost-effectiveness ratio (ICER). Uncertainty was evaluated using one-way and probabilistic sensitivity analysis.

RESULTS

The effective treatment rate increased to 89.1% in the PEAC group compared with 62.1% in the no-consultation group. Patients in the PEAC group experienced a 2.1-day shorter duration of symptoms than those without consultation (15.5 days vs. 17.6 days, P = 0.04). The base case analysis estimated that the PEAC group gained 0.189 quality-adjusted life years (QALYs) at a cost of $18,209.7, while the no-consultation group gained 0.177 QALYs at a cost of $23,831.1. The PEAC group was more cost-effective, yielding an ICER of - $475,499.0 per QALY gained. Probabilistic sensitivity analysis indicated that PEAC was cost-effective in 60.1% of cases, with costs remaining below the willingness-to-pay (WTP) threshold, supporting PEAC as a cost-effective strategy for managing MDRO infections.

CONCLUSION

Pharmacist Early Active Consultation was a more cost-effective strategy than no consultation for treating MDRO infections in patients in China.

Recognition of Serious Infections in the Elderly Visiting the Emergency Department: The Development of a Diagnostic Prediction Model (ROSIE)

Background/Objectives: Serious infections in older adults are associated with substantial mortality and morbidity. Diagnosis is challenging because of the non-specific presentation and overlap with pre-existing comorbidities. The objective of this study was to develop a clinical prediction model using clinical features and biomarkers to support emergency care physicians in diagnosing serious infections in acutely ill older adults. Methods: We conducted a prospective cross-sectional diagnostic study, consecutively including acutely ill patients (≥65 year) presenting to the emergency department. Clinical information and blood samples were collected at inclusion by a trained study nurse. A prediction model for any serious infection was developed based on ten candidate predictors that were further reduced to four ad interim using a penalized Firth multivariable logistic regression model. We assessed discrimination and calibration of the model after internal validation using bootstrapping. Results: We included 425 participants at three emergency departments, of whom 215 were diagnosed with a serious infection (51%). In the final model, we retained systolic blood pressure, oxygen saturation, and C-reactive protein as predictors. This model had good discriminatory value with an Area Under the Receiver Operating Characteristic (AUROC) curve of 0.82 (95% CI: 0.78 to 0.86) and a calibration slope of 0.96 (95% CI: 0.76 to 1.16) after internal validation. Addition of procalcitonin did not improve the discrimination of the model. Conclusions: The ROSIE model uses three predictors that can be easily and quickly measured in the emergency department. It provides good discriminatory power after internal validation. Next steps should include external validation and an impact assessment.

How Should We Manage the Impact of Antimicrobial Resistance in Patients With Cancer? An Oncological and Infectious Disease Specialist Point of View

Patients with solid tumors present a higher risk of infectious diseases with worse outcomes compared with immunocompetent patients. Prolonged treatment of prophylactic and empirically chosen antibiotics and health care-acquired infections can predispose patients with cancer to infections with antimicrobial-resistant (AMR) organisms. AMR is a global health priority and can affect patients with cancer. The outcome of patients with cancer worsens dramatically if multidrug-resistant (MDR) microorganisms cause infections. Moreover, the emergence of MDR organisms increases health care costs. Antimicrobial stewardship programs can be useful to monitor and improve the use of antibiotics in all oncological settings, including the palliative setting. Awareness of the magnitude of these issues is still low, so it is important to inform and educate oncologists. This narrative review aims to illustrate the main evidence on infections caused by AMR organisms in patients with cancer and the tools that oncologists should have to enhance their multidisciplinary management.