Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK

BACKGROUND

Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus.

AIM

To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe.

METHODS

The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls.

FINDINGS

In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis.

CONCLUSION

The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Impact of Finishing and Polishing Procedures on CAD/CAM In Vitro Milled Ceramics Surfaces: A Systematic Review

INTRODUCTION AND OBJECTIVES

CAD/CAM prostheses may be produced in prosthetic laboratories or directly by practitioners. Quality of ceramic polishing procedures is a controversial topic and it would be interesting for practitioners working with CAD/CAM devices to determine which method is the most efficient regarding finishing and polishing. This systematic review aims to evaluate the impact of different finishing and polishing procedures on the surface of milled ceramics.

MATERIALS AND METHODS

A precise request was launched on the PubMed database. Studies included if they met the criteria of a specifically prepared PICO search. A first selection was performed by analysing titles and abstracts: the articles presenting a study conducted on non-CAD/CAM milled ceramics and research not containing comparisons of finishing procedures were not included. Roughness was evaluated in 15 articles. Nine papers recommended mechanical polishing over glazing regardless of the type of ceramic used. However, no significant differences were detected between the surface roughness of glazed and polished ceramics in nine other publications.

CONCLUSIONS

there is no scientific evidence demonstrating the superiority of hand polishing over glazing on CAD/CAM-milled ceramics.

Contributory conditions for unexpected COVID-19 cases and nosocomial COVID-19 infection cases identified from systematic investigation in a French University Hospital

INTRODUCTION

Nosocomial case (NC) of COVID-19 infections is a challenge for hospitals. We report the results of a seven-month prospective cohort study investigating COVID-19 patients to assess unexpected cases (UC) (no COVID-19 precautionary measure application since admission) and NC.

PATIENTS AND METHODS

Investigation by an infection control team of 844 patients with COVID-19 infection hospitalized for more than 24 hours (cases).

RESULTS

A total of 301 UC were identified (31% after contact tracing) with a total of 129 contact patients, and 27 secondary cases for 59 of them. In geriatric wards, 50% of cases were UC. NC represented 18% of cases (37% in geriatric wards), mainly identified after contact tracing of wandering cases.

CONCLUSION

A rapid infection control response is essential to contain nosocomial transmission, along with detailed contact tracing and screening policy. Dealing with wandering elderly patients remain challenging for HCWs.

FUSARIUM HEAD BLIGHT SYMPTOM DISCRIMINATION: A USEFUL TOOL IN THE FIELD EVALUATION OF FUNGICIDE TREATMENTS

Fusarium head blight (FHB) is one of the major diseases affecting wheat. It is caused by a complex of fungal species, resulting in yield losses and health problems due to mycotoxin production. The presence of multiple fungal species on wheat ears, with varying responses to active fungicide ingredients used in the field, makes the disease difficult to manage. In order to evaluate the efficacy of the timing of applications (at GS 39, GS 61 and GS 39+61) of a prothioconazole + fluoxastrobin-based fungicide, a 2-year field trial was conducted in Belgium. In both years, applications at GS 61 and GS 39+61 resulted in a significant reduction in symptom severity on ears and in deoxynivalenol (DON) content compared with the untreated control in 2013. In 2012, when Microdochium spp. were the most prevalent species, the treatment at GS 39 significantly reduced ear symptoms. Fusarium graminearum was predominant in the second year (2013) and caused significant DON accumulation in the grain after a single foliar spraying. The two genera were characterized by distinct types of symptoms: grouped bleached spikelet's for F. graminearum and isolated bleached spikelet's for Microdochium spp. This difference enabled the significant effect of the double treatments on symptoms caused by Microdochium spp. to be determined in the second year. This effect, which was also visible on leaf symptoms, suggests that Microdochium spp. epidemics in wheat might be polycyclic. Discrimination between symptoms caused by F. graminearum and Microdochium spp. could be a useful tool to study FHB management using fungicide treatments.

Hepatitis C of genotype 2: the role of medical invasive exams

BACKGROUND AND AIM

Hepatitis C virus genotype 2 is the third in order of frequency in Belgium. The aim of this study was to better define the genotype 2 carriers' epidemiology characteristics.

METHODS

In a database comprising 1726 viremic hepatitis C virus patient from the south part of Belgium, the files of 98 genotype 2 carriers were reviewed.

RESULTS

There was a strong association between genotype 2 and the mode of transmission. The rate of contamination by invasive medical exams was very high (23%), and statistically different from the one of the others genotypes. Eligibility for antiviral therapies and the rate of sustained viral response were high.

CONCLUSION

HCV genotype 2 was highly associated with transmission by invasive medical exams.

Learning from radiation incidents: the new OTHEA website

OTHEA is the name of a new website (www.othea.net), created by the Health Protection Agency (UK) and the Centre d'étude sur l'évaluation de la protection dans le domaine nucléaire (CEPN, France), and supported by several other stakeholders including national societies and associations. The website is bi-lingual (French and English) and the purpose is to share the lessons learnt from radiological incidents that have occurred in the industrial, medical, research and teaching, and other non-nuclear sectors. OTHEA contains a collection of incident reports, categorised according to the sector and the type of application, and a search facility. The reports can be freely downloaded and printed, for example for use in radiation protection training activities. To encourage dissemination, the incident reports have been made anonymous, i.e. any information that could identify a particular individual, organisation or site has been removed. Each report contains a brief summary of the incident, the radiological consequences, and the lessons learnt. The aim is not to capture every single incident, but to provide a range of reports selected according to the value of the lessons learnt. For OTHEA to be a long-term success, it needs to be sustained with new reports. Therefore users are encouraged to submit incident reports that can be considered for inclusion in OTHEA. This note summarises the background to OTHEA, and provides a description of the operating features and content at its launch in summer 2010.

Black pigments in the liver related to gold and titanium deposits. A report of four cases

Black pigments are rarely described in the liver. We report four patients with chronic cholestasis and black pigments described on liver histological examination. Energy-dispersive X-ray analysis identified these black pigments as gold particles in the first three patients and titanium particles in the fourth. The origin of the gold deposits was unknown in this first patient and related to gold salts therapy in the two others. Titanium deposits was associated with hepatic granulomas and related to total knee replacement.

[Clinical case of the month: clostridium difficile colitis]

A 55-year-old patient with mant e cels underwent a cytotoxic chemotherapy (D.H.A.P. + Rituximab). During the medullar aplasia related to the third cycle, diarrhoea due to Clostridium difficile arised and relapsed 15 days later despite normal blood counts. This colitis was very severe with pluribacterial peritonitis, but resolved with intensive medical treatment. The incidence, the patient's risk factors, the iatrogenic and nosocomial characters of cl. difficile colitis are discussed.

Acute effects of captopril on systemic and renal hemodynamics and on renal function in cirrhotic patients with ascites

The reduction of angiotensin II production by captopril--an angiotensin-converting enzyme inhibitor--could suppress hyperaldosteronism without impairment of renal function and could thereby be useful in the treatment of ascites in patients with cirrhosis. Systemic and renal hemodynamics and renal function were studied in 6 nonazotemic patients with cirrhosis and ascites with a low-sodium diet before and after oral administration of 25 mg of captopril. Cardiac output and renal blood flow did not change significantly after administration of captopril, whereas mean arterial pressure significantly decreased. Systemic and renal vascular resistances were significantly reduced. There was a statistically significant reduction of glomerular filtration rate, filtration fraction, and urinary output. Plasma renin activity significantly increased in all patients after administration of captopril. A statistically significant correlation was found between the decrease in mean arterial pressure and the reduction of glomerular filtration, but no relationship was found between basal values of plasma renin activity and the other observed variations. We concluded that captopril mainly induces hypotension due to an increase in renal vasodilatation in ascitic patients with cirrhosis.

Oral zinc supplementation improves hepatic encephalopathy. Results of a randomised controlled trial

22 cirrhotic patients with chronic encephalopathy were given oral zinc supplementation or placebo in a double-blind randomised trial. In the group which received zinc acetate 600 mg a day for 7 days, serum zinc had been restored to normal by day 8. On day 8 hepatic encephalopathy, as assessed by a trailmaking test, was improved in the supplemented group but not in the placebo group. There was also a significant increase in blood urea nitrogen in the supplemented group. Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea. The duration of this improvement requires further investigation.

Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis

In patients with alcoholic cirrhosis, wedged hepatic venous pressure closely reflects portal venous pressure. This study was carried out to determine if propranolol-induced reductions in portal venous pressure are accurately evaluated by the measurement of wedged hepatic venous pressure. Hepatic venous cannulation and percutaneous transhepatic catheterization of the portal vein were simultaneously performed in 7 patients with alcoholic cirrhosis. One hour after oral administration of 40 mg of propranolol, wedged hepatic and portal venous pressures significantly decreased from 24.3 +/- 3.5 (mean +/- SD) to 19.0 +/- 3.0 mmHg, and from 24.7 +/- 3.9 to 22.4 +/- 3.6 mmHg, respectively. Although no significant difference was found between baseline wedged hepatic and portal venous pressures, a significant difference was found between these pressures after propranolol administration. We concluded that during acute administration of a drug acting on the splanchnic circulation, the measurement of wedged hepatic venous pressure may not provide a reliable estimation of the magnitude of the changes in portal venous pressure. There is, however, no evidence that the direction of the changes might not be adequately assessed by wedged hepatic venous pressure measurement.

Assessment of beta-adrenergic blockade with propranolol in patients with cirrhosis

Fourteen patients with cirrhosis and bleeding esophageal varices were treated with propranolol. The dose of propranolol was determined by decreasing the resting heart rate by 25% 12 hr after an oral dose of propranolol which was given twice a day. Significant decreases in the hepatic venous pressure gradient and cardiac output after 1 month of propranolol administration was observed. To assess beta-adrenergic blockade, the isoproterenol test and plasma propranolol levels were evaluated. Increasing doses of isoproterenol were injected to increase the resting heart rate 25 beats per minute (chronotropic dose 25 or CD25 ). Plasma propranolol concentrations were measured in blood samples drawn 4 hr after the last oral dose. The mean CD25 was 5 +/- 2 micrograms before and 146 +/- 84 micrograms after 1 month of propranolol administration. The plasma propranolol level after 1 month of drug administration was 0.69 +/- 0.47 microM per liter i.e. 2.33 +/- 1.59 micrograms per ml. A significant correlation was found between the CD25 measured after continuous propranolol administration and plasma propranolol level. In conclusion, the efficacy of beta-adrenergic blockade was estimated by the isoproterenol test which correlates with the plasma propranolol level in patients with cirrhosis. This study suggests that the isoproterenol test is useful in assessing beta-adrenergic blockade with propranolol in patients with cirrhosis.

[Systemic circulatory hyperkinetic syndrome in patients with cirrhosis. Relation with hepatocellular failure and portal hypertension]

Hyperkinetic circulatory state is common in patients with cirrhosis but the cause of this syndrome has not been clearly elucidated. Systemic hemodynamic changes and their relationship to liver failure and splanchnic hemodynamics were studied in 100 patients with cirrhosis and were compared to a group of 15 patients without portal hypertension. Cardiac output was significantly higher and systemic vascular resistance was significantly lower in cirrhotic patients than in control patients. Multivariate analysis revealed that among different clinical, biochemical and splanchnic hemodynamic data, serum albumin, serum bilirubin, plasma prothrombin, and gastrointestinal bleeding significantly and independently explained the variation of cardiac output and systemic vascular resistance. No relationship was found between hepatic venous pressures or the presence of ascites and the hyperkinetic syndrome. From these results, it is concluded that in patients with cirrhosis liver failure is partly responsible for the hyperkinetic state.

Effects of propranolol on renal blood flow and renal function in patients with cirrhosis

Systemic and splanchnic hemodynamics, renal blood flow, and renal function were studied in 13 patients with cirrhosis both before and 1 h after oral administration of 40 mg of propranolol (acute administration) and 1 mo after continuous administration of this substance at doses reducing the heart rate by 25% (chronic administration). Cardiac output and the gradient between wedged and free hepatic venous pressures significantly decreased after acute and chronic administration of propranolol; mean arterial pressure did not change significantly and systemic vascular resistance significantly increased. Renal blood flow and renal vascular resistance did not change significantly after acute administration of propranolol and renal function did not change significantly after acute or chronic administration of propranolol. We conclude that propranolol does not alter renal function in patients with cirrhosis who are in good physical condition.

Hemodynamic changes in patients with portal venous obstruction

Splanchnic and systemic hemodynamics were evaluated in five adult patients with portal hypertension due to portal venous obstruction and were compared with those of patients with cirrhosis and those of a control group. In patients with portal venous obstruction, the gradient between wedged and free hepatic venous pressures ranged from 2 to 3 mm Hg, as in the control group, and was significantly lower than in patients with cirrhosis. Hepatic blood flow averaged 0.521 +/- 0.127 liter per min per m2 (mean +/- S.D.) and was significantly lower than that measured in cirrhotic and normal patients. Cardiac index averaged 3.788 +/- 0.629 liters per min per m2; this high value for cardiac index was not significantly different from that measured in cirrhotic patients, but was significantly higher than in patients of the control group. It is suggested that a hyperkinetic circulatory state may result from the development of portal-systemic venous collateral circulation in patients with portal venous obstruction having normal liver and hepatic venous pressures.

[Physiopathology of non-ketotic hyperosmolar coma in diabetes (author's transl)]

Hyperosmolar diabetic coma is characterised by extreme hyperglycaemia and dehydration. Hypernatremia often contributes additionally to plasma hyperosmolarity. The pathogenesis of these component abnormalities is considered. The explanation of the absence of hyperketonaemia is examined in the light of recent experimental and clinical data. At the beginning of the development of the syndrome, high peripheral plasma insulin probably explains the lack of ketosis via inhibition of lipolysis. Later, when hyperosmolar coma is established, peripheral insulinopenia but an "insulinised" liver may coexist. This would favour metabolism of free fatty acids along nonketogenic pathways.