Hospital-acquired Clostridium difficile infection: an institutional costing analysis

Utilization of Antibacterial Nanoparticles in Photocurable Additive Manufacturing of Advanced Composites for Improved Public Health

This paper presents the additive manufacturing and characterization of nanoparticle-reinforced photocurable resin-based nanocomposites with a potential antimicrobial function for improved public health applications. Two types of photocurable resins are reinforced by titanium dioxide (TiO₂) or zinc oxide (ZnO) nanoparticles with average diameters in the 10-30 nm range to provide antimicrobial properties. The developed nanocomposites can be additively manufactured using the digital light processing method with an outstanding surface quality and precise geometrical accuracy. Experimental characterizations are conducted to investigate key mechanical properties of the 3D printed nanocomposites, including Young's Modulus, tensile strength, and abrasion resistance. Specimens produced were observed to demonstrate the following characteristics during testing. Tensile strength increased by 42.2% at a maximum value of 29.53 MPa. The modulus of elasticity increased by 14.3%, and abrasion resistance increased by 15.8%. The proper dispersion of the nanoparticles within the cured resin is validated by scanning electron images. The wettability and water absorption testing results indicate that the developed nanocomposites have an outstanding water resistance capability. The pairing of digital light processing with these novel nanocomposites allows for the creation of complex composite geometries that are not capable through other manufacturing processes. Therefore, they have the potential for long-term usage to improve general public health with antimicrobial functionality. The pairing of an unmodified photocurable resin with a 1% ZnO concentration demonstrated the most promise for commercial applications.

Performance of the QIAstat-Dx Gastrointestinal Panel for Diagnosing Infectious Gastroenteritis

Detection and identification of enteropathogens that cause infectious gastroenteritis are essential steps for appropriate patient treatment and effective isolation precautions. Several syndrome-based tests have recently become available, with the gastrointestinal panel (GIP) assay on the QIAstat-Dx as the most recent addition to the syndromic testing landscape.

Detection and identification of enteropathogens that cause infectious gastroenteritis are essential steps for appropriate patient treatment and effective isolation precautions. Several syndrome-based tests have recently become available, with the gastrointestinal panel (GIP) assay on the QIAstat-Dx as the most recent addition to the syndromic testing landscape. The QIAstat-Dx GIP assay offers simultaneous testing for 24 bacterial, viral, and parasitic enteropathogens using a single test that reports the results in 70 min. In this study, we compared the performance of the GIP assay to laboratory-developed real-time PCR assays (LDTs), using 172 prospectively and retrospectively collected fecal samples from patients suspected to have infectious gastroenteritis. The GIP assay detected 97/107 enteropathogens (91%) that were detected by LDTs, and the overall agreement of results increased to 95% when excluding discrepant results with cycle threshold (C_T) values of >35. Further, the GIP assay detected 42 additional enteropathogens that were not detected, or tested, by LDTs. These included 35 diarrheagenic Escherichia coli targets for which the clinical relevance is unclear for most. The main advantage of the QIAstat-Dx system compared to other syndromic testing systems is the ability to generate C_T values that could help with the interpretation of results. However, compared to LDTs, the GIP assay is limited by flexibility and high-throughput testing. In conclusion, the GIP assay offers an easy, sample-to-answer workflow with a rapid detection of the most common enteropathogens and therefore has the potential to direct appropriate therapy and infection control precautions.

Direct cost of health care for individuals with community associated Clostridium difficile infections: A population-based cohort study

Background

Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI.

Methods

All individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI.

Results

Of all CDIs, 30–40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90^th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209–489).

Conclusions

Health care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.