Development, impact and outcomes of the Hull Bacteraemia Service

BACKGROUND

Bacteraemia is a significant cause of mortality and healthcare expenditure. Evidence suggests that consultation by an infection specialist may improve outcomes.

AIM

To review the characteristics and outcomes of patients seen by a newly implemented bacteraemia service.

METHODS

Retrospective review of data collected at time of consultation. Economic analyses and benchmarking of outcomes were also performed.

RESULTS

One hundred and fifty-one patients were seen by the service over an 18-month period. Staphylococcus aureus was the most common isolate and central venous lines the most common source. Antibiotics were changed and additional investigations suggested in 62% and 61% of patients, respectively. The 30-day mortality was 19%. Implementation and delivery of the service over the 18-month study period cost pound 22,663 (pound 15,109 per year). The cost per change in antibiotic prescription was pound 244. The cost per 'near-miss' detected was pound 1193. Overall mortality was no higher and possibly lower than in published studies.

CONCLUSION

We believe that this model of care may be suitable for the management of patients with bacteraemia. A study assessing the cost-effectiveness of this approach is required.

An unusual case of endocarditis

A 74 year gentleman was admitted with a 6 month history of dizzy spells, malaise, generalised weakness and weight loss of over a stone. He attributed his weight loss to poor appetite due to persistent nausea. He had no significant past medical history apart from moderate mitral regurgitation and recent cholecystectomy. He felt some of these symptoms began after laparoscopic cholecystectomy 12 months before. The procedure had been complicated by a self-limiting biliary leak. He had been recently evaluated by chest physicians and gastroenterologists for clubbing and weight loss. Computerised tomography (CT) of the chest showed right basal fibrosis, CT of the abdomen and pelvis was normal, and upper endoscopy revealed a non-obstructive mild pyloric stenosis. Routine blood tests were unremarkable.

Targeting attention on local vulnerabilities using an integrated index approach: the example of the climate vulnerability index

It is known that climate impacts can have significant effects on the environment, societies and economies. For human populations, climate change impacts can be devastating, giving rise to economic disruption and mass migration as agricultural systems fail, either through drought or floods. Such events impact significantly, not only where they happen, but also in the neighbouring areas. Vulnerability to the impacts of climate change needs to be assessed, so that adaptation strategies can be developed and populations can be protected. In this paper, we address the issue of vulnerability assessment through the use of an indicator approach, the climate vulnerability index (CVI). We show how this can overcome some of the difficulties of incommensurability associated with the combination of different types of data, and how the approach can be applied at a variety of scales. Through the development of nested index values, more reliable and robust coverage of large areas can be achieved, and we provide an indication of how this could be done. While further work is required to improve the methodology through wider application and component refinement, it seems likely that this approach will have useful application in the assessment of climate vulnerability. Through its application at sub-national and community scales, the CVI can help to identify those human populations most at risk from climate change impacts, and as a result, resources can be targeted towards those most in need.