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Meretsky CR, Krumbach B, Schiuma AT. A Comparative Analysis of Prophylactic Antibiotic Administration in Emergency Surgery Versus Elective Surgery: A Comprehensive Review. Cureus 2024; 16:e57338. [PMID: 38690454 PMCID: PMC11060617 DOI: 10.7759/cureus.57338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
Surgical site infections (SSIs) contribute to increased patient morbidity, prolonged hospital stays, and substantial healthcare costs. Prophylactic antibiotics play a pivotal role in mitigating the risk of SSIs, with their administration being a standard practice before both emergency and elective surgeries. This paper provides a comprehensive review and comparative analysis of the benefits of prophylactic antibiotic administration in emergency surgery versus elective surgery. Through a systematic literature review and analysis of relevant studies identified through PubMed searches, this paper highlights the specific benefits of prophylactic antibiotics between emergency and elective surgeries. The findings underscore the importance of tailored antibiotic regimens and administration protocols to optimize patient care and promote successful surgical outcomes in diverse clinical settings. Further research is warranted to refine guidelines and enhance understanding of the relationship between prophylactic antibiotics and surgical outcomes across different surgical contexts.
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Affiliation(s)
| | - Brandon Krumbach
- Surgery, St. George's University School of Medicine, Great River, USA
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Blair WO, Ellis MA, Fada M, Wiggins AA, Wolfe RC, Patel GP, Brockhaus KK, Droege M, Ebbitt LM, Kramer B, Likar E, Petrucci K, Shah S, Taylor J, Bingham P, Krabacher S, Moon JH, Rogoz M, Jean-Jacques E, Cleary RK, Eke R, Findley R, Parrish RH. Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework. Healthcare (Basel) 2023; 11:3060. [PMID: 38063628 PMCID: PMC10706554 DOI: 10.3390/healthcare11233060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. METHODS AND MATERIALS Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. RESULTS POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. CONCLUSIONS Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals.
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Affiliation(s)
- William Olin Blair
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Mary Allison Ellis
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Maria Fada
- Heritage School of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA;
| | - Austin Allen Wiggins
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachel C. Wolfe
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO 63110, USA;
| | - Gourang P. Patel
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Kara K. Brockhaus
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Molly Droege
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Laura M. Ebbitt
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Brian Kramer
- Department of Pharmacy Services, OhioHealth/Grant Medical Center, Columbus, OH 43215, USA;
| | - Eric Likar
- Department of Pharmacy Services, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Kerilyn Petrucci
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Sapna Shah
- Department of Pharmacy Services, Beaumont Hospital—Troy, Troy, MI 48085, USA;
| | - Jerusha Taylor
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Paula Bingham
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Samuel Krabacher
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Jin Hyung Moon
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Monica Rogoz
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Edson Jean-Jacques
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Robert K. Cleary
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Ransome Eke
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachelle Findley
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Richard H. Parrish
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
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Vicentini C, Gianino MM, Corradi A, Marengo N, Bordino V, Corcione S, De Rosa FG, Fattore G, Zotti CM. Cost-Effectiveness Analysis of the Prophylactic Use of Ertapenem for the Prevention of Surgical Site Infections after Elective Colorectal Surgery. Antibiotics (Basel) 2021; 10:antibiotics10030259. [PMID: 33806477 PMCID: PMC7999678 DOI: 10.3390/antibiotics10030259] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 02/15/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Standard surgical antimicrobial prophylaxis (SAP) regimens are less effective in preventing surgical site infections (SSIs) due to rising antimicrobial resistance (AMR) rates, particularly for patients undergoing colorectal surgery. This study aimed to evaluate whether ertapenem should be a preferred strategy for the prevention of SSIs following elective colorectal surgery compared to three standard SAP regimens: amoxicillin-clavulanate, cefoxitin, and cefazolin plus metronidazole. A cost-effectiveness analysis was conducted using decision tree models. Probabilities of SSIs and AMR-SSIs, costs, and effects (in terms of quality-adjusted life-years) were considered in the assessment of the alternative strategies. Input parameters integrated real data from the Italian surveillance system for SSIs with data from the published literature. A sensitivity analysis was conducted to assess the potential impact of the decreasing efficacy of standard SAP regimens in preventing SSIs. According to our models, ertapenem was the most cost-effective strategy only when compared to amoxicillin-clavulanate, but it did not prove to be superior to cefoxitin and cefazolin plus metronidazole. The sensitivity analysis found ertapenem would be the most cost-effective strategy compared to these agents if their failure rate was more than doubled. The findings of this study suggest ertapenem should not be a preferred strategy for SAP in elective colorectal surgery.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
- Correspondence: ; Tel.: +39-011-670-5830; Fax: +39-011-670-5889
| | - Maria Michela Gianino
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
| | - Alessio Corradi
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
| | - Noemi Marengo
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
| | - Valerio Bordino
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Giovanni Fattore
- Department of Social and Political Sciences and CERGAS-SDA, Bocconi University, Via Roentgen 1, 20136 Milan, Italy;
| | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 Bis, 10126 Turin, Italy; (M.M.G.); (A.C.); (N.M.); (V.B.); (C.M.Z.)
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Abstract
Surgical site infection (SSI) following colorectal surgery is associated with worse postoperative outcomes, longer length of stay, and higher rates of readmission. SSI rates have been established as a surrogate metric for the overall quality of surgical care and are intricately tied to financial incentives and the public reputation of an institution. While risk factors and prevention mechanisms for SSI are well established, the rates of SSI remain high. This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices.
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Affiliation(s)
- Megan C Turner
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John Migaly
- Division of Advanced GI and Oncologic Surgery, Duke University Medical Center, Durham, North Carolina
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5
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Purba AKR, Setiawan D, Bathoorn E, Postma MJ, Dik JWH, Friedrich AW. Prevention of Surgical Site Infections: A Systematic Review of Cost Analyses in the Use of Prophylactic Antibiotics. Front Pharmacol 2018; 9:776. [PMID: 30072898 PMCID: PMC6060435 DOI: 10.3389/fphar.2018.00776] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/26/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction: The preoperative phase is an important period in which to prevent surgical site infections (SSIs). Prophylactic antibiotic use helps to reduce SSI rates, leading to reductions in hospitalization time and cost. In clinical practice, besides effectiveness and safety, the selection of prophylactic antibiotic agents should also consider the evidence with regard to costs and microbiological results. This review assessed the current research related to the use of antibiotics for SSI prophylaxis from an economic perspective and the underlying epidemiology of microbiological findings. Methods: A literature search was carried out through PubMed and Embase databases from 1 January 2006 to 31 August 2017. The relevant studies which reported the use of prophylactic antibiotics, SSI rates, and costs were included for analysis. The causing pathogens for SSIs were categorized by sites of the surgery. The quality of reporting on each included study was assessed with the “Consensus on Health Economic Criteria” (CHEC). Results: We identified 20 eligible full-text studies that met our inclusion criteria, which were subsequently assessed, studies had in a reporting quality scored on the CHEC list averaging 13.03 (8–18.5). Of the included studies, 14 were trial-based studies, and the others were model-based studies. The SSI rates ranged from 0 to 71.1% with costs amounting to US$480-22,130. Twenty-four bacteria were identified as causative agents of SSIs. Gram negatives were the dominant causes of SSIs especially in general surgery, neurosurgery, cardiothoracic surgery, and obstetric cesarean sections. Conclusions: Varying results were reported in the studies reviewed. Yet, information from both trial-based and model-based costing studies could be considered in the clinical implementation of proper and efficient use of prophylactic antibiotics to prevent SSIs and antimicrobial resistance.
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Affiliation(s)
- Abdul K R Purba
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Didik Setiawan
- Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
| | - Erik Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Unit of PharmacoEpidemiology & Pharmacoeconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, Netherlands
| | - Jan-Willem H Dik
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alex W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Allen J, David M, Veerman JL. Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection. BJS Open 2018; 2:81-98. [PMID: 29951632 PMCID: PMC5989978 DOI: 10.1002/bjs5.45] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/12/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Surgical-site infections (SSIs) increase the length of hospital admission and costs. SSI prevention guidelines include preoperative antibiotic prophylaxis. This review assessed the reporting quality and cost-effectiveness of preoperative antibiotics used to prevent SSI. METHODS PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Index of Economic Articles (EconLit), Database of Abstracts of Reviews of Effect (including the National Health Service Economic Evaluation Database) and Cochrane Central databases were searched systematically from 1970 to 2017 for articles that included costs, preoperative antibiotic prophylaxis and SSI. Included were RCTs and quasi-experimental studies conducted in Organisation for Economic Co-operation and Development countries with participants aged at least 18 years and published in English. Two reviewers assessed eligibility, with inter-rater reliability determined by Cohen's κ statistic. The Consolidated Health Economic Evaluation and Reporting Standards (CHEERS) and modified Drummond checklists were used to assess reporting and economic quality. Study outcomes and characteristics were extracted, and incremental cost-effectiveness ratios were calculated, with costs adjusted to euros (2016) (€1 = US $1·25; £1 sterling = €1·28). RESULTS Twelve studies published between 1988 and 2014 were included from 646 records identified; nine were RCTs, two were nested within RCTs and one was a retrospective chart review. Study quality was highest in the nested studies. Cephalosporins (first, second and third generation) were the most frequent prophylactic interventions. Eleven studies demonstrated clinically effective interventions; ten were cost-effective (the intervention was dominant); in one the intervention was dominated by the control; and in one the intervention was more effective and more expensive than the control. CONCLUSION Preoperative antibiotic prophylaxis does reduce SSI, costs to hospitals and health providers, but the reporting of economic methods in RCTs is not standardized. Routinely nesting economic methods in RCTs would improve economic evaluations and ensure appropriate selection of prophylactic antibiotics.
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Affiliation(s)
- J. Allen
- Queensland Audit of Surgical Mortality, Royal Australasian College of SurgeonsBrisbaneQueenslandAustralia
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
| | - M. David
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
| | - J. L. Veerman
- School of Public HealthUniversity of QueenslandBrisbaneQueenslandAustralia
- School of MedicineGriffith UniversitySouthportQueenslandAustralia
- Cancer Council NSWWoolloomoolooNew South WalesAustralia
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7
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Septimus EJ, Coopersmith CM, Whittle J, Hale CP, Fishman NO, Kim TJ. Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multistakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis. Clin Infect Dis 2018; 65:1565-1569. [PMID: 29048513 DOI: 10.1093/cid/cix603] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022] Open
Abstract
The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. To promote the appropriate use of antimicrobials and combat antimicrobial resistance, the workgroup provides recommendations for appropriate antibiotics for the treatment of sepsis.
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Affiliation(s)
- Edward J Septimus
- Texas A&M Health Science Center College of Medicine.,Clinical Services Group, Hospital Corporation of America (HCA), Houston, Texas
| | | | - Jessica Whittle
- Department of Emergency Medicine, University of Tennessee College of Medicine, Chattanooga
| | - Caleb P Hale
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Thomas J Kim
- Infectious Diseases Society of America, Arlington, Virginia
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Abstract
Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of ‘value’, which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease.
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Affiliation(s)
- Talitha I Verhoef
- Department of Applied Health Research, University College London, Gower Street, London, WC1E 6BT, UK
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Leng XS, Zhao YJ, Qiu HZ, Cao YK, Zhu WH, Shen JF, Paschke A, Dai WM, Caldwell N, Wang J. Ertapenem prophylaxis of surgical site infections in elective colorectal surgery in China: a multicentre, randomized, double-blind, active-controlled study. J Antimicrob Chemother 2014; 69:3379-86. [DOI: 10.1093/jac/dku302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Zelhart MD, Hauch AT, Slakey DP, Nichols RL. Preoperative antibiotic colon preparation: have we had the answer all along? J Am Coll Surg 2014; 219:1070-7. [PMID: 25260679 DOI: 10.1016/j.jamcollsurg.2014.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/16/2014] [Accepted: 07/08/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Matthew D Zelhart
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
| | - Adam T Hauch
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Douglas P Slakey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Ronald L Nichols
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA
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11
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Stenson A. Perioperative Infections: Prevention and Therapeutic Options. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Abstract
Despite improvement in infection control measures and surgical practice, surgical site infections (SSIs) remain a major cause of morbidity and mortality. In colorectal surgery, perioperative administration of a suitable antimicrobial regimen that covers both anaerobic and aerobic bacteria is universally accepted. In a prospective, double-blind, randomized study ertapenem was recently found to be more effective than cefotetan, a parenteral cephalosporin so broadly used as to be considered as gold standard in the prevention of SSIs following colorectal surgery. In this adequate and well controlled study, the superiority of ertapenem over cefotetan was clearly demonstrated from the clinical and bacteriological points of view. However, data that directly compares ertapenem with other antimicrobial regimen effective in preventing SSIs following colorectal surgery are lacking; furthermore, the possible risk of promotion of carbapenem resistance associated with widespread use of ertapenem prophylaxis as well as the ertapenem effects on the intestinal gut flora are of concern. Further comparative studies of ertapenem versus other widely used prophylactic regimens for colorectal surgery in patients submitted to mechanical bowel preparation versus no preparation as well as further research on adverse events of antibiotic prophylaxis, including emergence of resistance and Clostridium difficile infection, seem warranted.
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Affiliation(s)
- Fausto de Lalla
- Libero Docente of Infectious Diseases, University of Milano, Milano, Italy
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