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Donnelly D, Pillinger KE, Debnath A, DePasquale W, Munsiff S, Louie T, Jones CMC, Shulder S. Cost evaluation of continuation of therapy with dalbavancin compared to standard-of-care antibiotics alone in hospitalized persons who inject drugs with severe gram-positive infections. Am J Health Syst Pharm 2024; 81:S40-S48. [PMID: 38465838 DOI: 10.1093/ajhp/zxae025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Persons who inject drugs (PWID) are at risk for severe gram-positive infections and may require prolonged hospitalization and intravenous (IV) antibiotic therapy. Dalbavancin (DBV) is a long-acting lipoglycopeptide that may reduce costs and provide effective treatment in this population. METHODS This was a retrospective review of PWID with severe gram-positive infections. Patients admitted from January 1, 2017, to November 1, 2019 (standard-of-care [SOC] group) and from November 15, 2019, to March 31, 2022 (DBV group) were included. The primary outcome was the total cost to the healthcare system. Secondary outcomes included hospital days saved and treatment failure. RESULTS A total of 87 patients were included (37 in the DBV group and 50 in the SOC group). Patients were a median of 34 years old and were predominantly Caucasian (82%). Staphylococcus aureus (82%) was the most common organism, and bacteremia (71%) was the most common type of infection. Compared to the SOC group, the DBV group would have had a median of 14 additional days of hospitalization if they had stayed to complete their therapy (P = 0.014). The median total cost to the healthcare system was significantly lower in the DBV group than in the SOC group ($31,698.00 vs $45,093.50; P = 0.035). The rate of treatment failure was similar between the groups (32.4% in the DBV group vs 36% in the SOC group; P = 0.729). CONCLUSION DBV is a cost-saving alternative to SOC IV antibiotics for severe gram-positive infections in PWID, with similar treatment outcomes. Larger prospective studies, including other patient populations, may demonstrate additional benefit.
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Affiliation(s)
- Devin Donnelly
- Department of Pharmacy, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | | | | | - William DePasquale
- Department of Pharmacy, University of Rochester Medical Center: Highland Hospital, Rochester, NY, USA
| | - Sonal Munsiff
- Division of Infectious Diseases, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Ted Louie
- Division of Infectious Diseases, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Courtney Marie Cora Jones
- Department of Emergency Medicine, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
| | - Stephanie Shulder
- Department of Pharmacy, University of Rochester Medical Center: Strong Memorial Hospital, Rochester, NY, USA
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Zhen X, Lundborg CS, Sun X, Hu X, Dong H. Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review. Antimicrob Resist Infect Control 2019; 8:137. [PMID: 31417673 PMCID: PMC6692939 DOI: 10.1186/s13756-019-0590-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/31/2019] [Indexed: 02/03/2023] Open
Abstract
Background Antibiotic resistance (ABR) is one of the biggest threats to global health. Infections by ESKAPE (Enterococcus, S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, and E. coli) organisms are the leading cause of healthcare-acquired infections worldwide. ABR in ESKAPE organisms is usually associated with significant higher morbidity, mortality, as well as economic burden. Directing attention towards the ESKAPE organisms can help us to better combat the wide challenge of ABR, especially multi-drug resistance (MDR). Objective This study aims to systematically review and evaluate the evidence of the economic consequences of ABR or MDR ESKAPE organisms compared with susceptible cases or control patients without infection/colonization in order to determine the impact of ABR on economic burden. Methods Both English-language databases and Chinese-language databases up to 16 January, 2019 were searched to identify relevant studies assessing the economic burden of ABR. Studies reported hospital costs (charges) or antibiotic cost during the entire hospitalization and during the period before/after culture among patients with ABR or MDR ESKAPE organisms were included. The costs were converted into 2015 United States Dollars. Disagreements were resolved by a third reviewer. Results Of 13,693 studies identified, 83 eligible studies were included in our review. The most studied organism was S. aureus, followed by Enterococcus, A. baumannii, E. coli, E. coli or/and K. pneumoniae, P. aeruginosa, and K. pneumoniae. There were 71 studies on total hospital cost or charge, 12 on antibiotic cost, 11 on hospital cost or charge after culture, 4 on ICU cost, 2 on hospital cost or charge before culture, and 2 on total direct and indirect cost. In general, ABR or MDR ESKAPE organisms are significantly associated with higher economic burden than those with susceptible organisms or those without infection or colonization. Nonetheless, there were no differences in a few studies between the two groups on total hospital cost or charge (16 studies), antibiotic cost (one study), hospital cost before culture (one study), hospital cost after culture (one study). Even, one reported that costs associated with MSSA infection were higher than the costs for similar MRSA cases. Conclusions ABR in ESKAPE organisms is not always, but usually, associated with significantly higher economic burden. The results without significant differences may lack statistical power to detect a significant association. In addition, study design which controls for severity of illness and same empirical antibiotic therapy in the two groups would be expected to bias the study towards a similar, even negative result. The review also highlights key areas where further research is needed.
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Affiliation(s)
- Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
- Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Stålsby Lundborg
- Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
| | - Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, No. N1, Shancheng Avenue, Yiwu City, Zhejiang China
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Barnacle J, Wilson D, Little C, Hoffman C, Raymond N. Excess cost and inpatient stay of treating deep spinal surgical site infections. N Z Med J 2018; 131:27-34. [PMID: 29771899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To determine the excess cost and hospitalisation associated with surgical site infections (SSI) following spinal operations in a New Zealand setting. METHODS We identified inpatients treated for deep SSI following primary or revision spinal surgery at a regional tertiary spinal centre between 2009 and 2016. Excess cost and excess length of stay (LOS) were calculated via a clinical costing system using procedure-matched controls. RESULTS Twenty-eight patients were identified. Twenty-five had metalware following spinal fusion surgery, while three had non-instrumented decompression and/or discectomy. Five were diagnosed during their index hospitalisation and 23 (82%) were re-admitted. The average excess SSI cost was NZ$51,434 (range $1,398-$262,206.16) and LOS 37.1 days (range 7-275 days). Infections following metalware procedures had a greater excess cost (average $56,258.90 vs. $11,228.61) and LOS (average 40.4 days vs. 9.7 days) than procedures without metalware. CONCLUSION The costs associated with spinal SSI are significant and comparable to a previous New Zealand study of hip and knee prosthesis SSI. More awareness of the high costs involved should encourage research and implementation of infection prevention strategies.
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Affiliation(s)
- James Barnacle
- Principal Medical Officer, Internal Medicine, Daeyang Luke Hospital, Malawi
| | - Dianne Wilson
- Manager, Business Intelligence and Analytics Unit, Grace Neill Block, Wellington Hospital, Wellington
| | - Christopher Little
- Infectious Diseases Pharmacist, Pharmacy Department, Wellington Hospital, Wellington
| | - Christopher Hoffman
- Consultant Orthopaedic Surgeon, Orthopaedic Service, Wellington Hospital, Wellington
| | - Nigel Raymond
- Infectious Diseases Physician, Infection Service, Wellington Hospital, Wellington
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Mitomi K, Hoai TD, Nishiki I, Yoshida T. First isolation of Weissella ceti responsible for outbreaks of weissellosis in farmed rainbow trout in Japan. J Fish Dis 2018; 41:847-850. [PMID: 29411388 DOI: 10.1111/jfd.12787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 06/08/2023]
Affiliation(s)
- K Mitomi
- Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
| | - T D Hoai
- Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
- Faculty of Fisheries, Vietnam National University of Agriculture, Hanoi, Vietnam
| | - I Nishiki
- Research Center for Bioinformatics and Biosciences, Japan Fisheries Research and Education Agency, National Research Institute of Fisheries Science, Yokohama, Japan
| | - T Yoshida
- Faculty of Agriculture, University of Miyazaki, Miyazaki, Japan
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Duszynska W, Taccone FS, Hurkacz M, Wiela-Hojenska A, Kübler A. Continuous vs. intermittent vancomycin therapy for Gram-positive infections not caused by methicillin-resistant Staphylococcus aureus. Minerva Anestesiol 2016; 82:284-293. [PMID: 26184702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of vancomycin pharmacokinetics (PKs) on effectiveness and safety in the treatment of Gram-positive infections due to pathogens other than methicillin-resistant Staphylococcus aureus (MRSA). METHODS Prospective study including septic patients received either continuous (N.=21) or intermittent (N.=21) infusions of vancomycin; the target drug concentration was 15-20 mg/L and target area under the curve of vancomycin concentrations over the minimum inhibitory concentration of the pathogen on day 1 (AUC24/MIC) >400. Clinical and microbiological responses, the development of acute kidney injury (AKI) and therapy costs were recorded. RESULTS The median AUC24/MIC was 195(133-343) vs. 189(136-328) mg/L*h in the continuous and intermittent infusion groups. Target drug concentrations were achieved in 15/21 vs. 9/21 (P=0.12) patients and AUC24/MIC>400 in only 5/21 vs. 3/21 (P=0.35) patients of continuous and intermittent groups, respectively. High clinical cure (17/21 for continuous vs. 17/21 for intermittent, P=1.00) and microbiological eradication (17/21 vs. 15/21, P=0.47) were observed in both groups and not associated with drug concentrations or with AUC24/MIC. AKI was diagnosed during therapy in 5/21 patients in the continuous group and 8/21 in the intermittent group (P=0.32). The median total therapy costs were lower in the continuous than in the intermittent group (377 [304-485] vs. 552 [371-644] €, P=0.04). CONCLUSIONS Vancomycin resulted in high clinical response during non-MRSA Gram-positive infections treatment even at drug concentrations lower than those for MRSA. A continuous infusion of vancomycin was associated with a significant reduction in therapy costs compared to intermittent infusions.
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Affiliation(s)
- Wieslawa Duszynska
- Department of Anesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland -
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Ektare V, Khachatryan A, Xue M, Dunne M, Johnson K, Stephens J. Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting. J Med Econ 2015; 18:1092-101. [PMID: 26368787 DOI: 10.3111/13696998.2015.1078339] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. METHODS Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. RESULTS Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). LIMITATIONS Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. CONCLUSION Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.
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Affiliation(s)
- V Ektare
- a Pharmerit International , Bethesda , MD , USA
| | | | - M Xue
- a Pharmerit International , Bethesda , MD , USA
| | - M Dunne
- b Durata Therapeutics , Chicago , IL , USA
| | - K Johnson
- b Durata Therapeutics , Chicago , IL , USA
| | - J Stephens
- a Pharmerit International , Bethesda , MD , USA
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Bodily M, McMullen KM, Russo AJ, Kittur ND, Hoppe-Bauer J, Warren DK. Discontinuation of reflex testing of stool samples for vancomycin-resistant enterococci resulted in increased prevalence. Infect Control Hosp Epidemiol 2013; 34:838-40. [PMID: 23838226 PMCID: PMC4689131 DOI: 10.1086/671276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Discontinuation of reflex testing of stool submitted for Clostridium difficile testing for vancomycin-resistant enterococci (VRE) led to an increase in the number of patients with healthcare-associated VRE bacteremia and bacteriuria (0.21 vs 0.36 cases per 1,000 patient-days; P<.01). Cost-benefit analysis showed reflex screening and isolation of VRE reduced hospital costs.
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Affiliation(s)
- Mandy Bodily
- Barnes-Jewish Hospital, Infection Prevention Department, Saint Louis, Missouri, USA.
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Hernández-Roca JJ, García-Vázquez E, Hernández A, Canteras M, Herrero JA, Cascales E, Mené-Fenor E, Gómez-Gómez J. [Bacteraemia at a second level hospital: epidemiological study, analysis of pronostic factors associated to mortality and economic cost estimation]. Rev Esp Quimioter 2013; 26:119-127. [PMID: 23817650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Bacteraemia (B) accounts for a considerable proportion (0.36%) of all hospital admissions due to infections diseases and it is associated to increased hospital costs. The aim of this study is to describe a cohort of patients with bacteraemia at a second level hospital, to analyze factors associated to mortality and its economical impact during hospital admission. PATIENTS AND METHODS Observational study of a cohort of adult patients with bacteraemia admitted at a second level hospital during 2010. Data collection from clinical records has been done according to a standard protocol: epidemiological and clinical variables and factors associated to mortality were analysed. Total economical cost per patient was estimated. RESULTS 148 patients were included: 80 community B (55.4%), 23 health care associated B (15.5%) and 45 nosocomial B (28.5%). The incidence was 9 cases 10.000 persons/year. Mean age was 69 years and the global mortality was 24%. In bivariate analysis smoking, diabetes mellitus, McCabe Jackson score type I-II, Pitt Index ≥ 3, APACHE ≥ 20, Glasgow ≤ 9, shock, respiratory distress, invasive procedures, nosocomial bacteraemia and inadequate empiric or definitive antibiotic treatment were associated to mortality (p<0.05). Factors associated to mortality in multivariate analysis included McCabe Jackson score type I-II (OR 4.95; 95% CI 1.095-22.38), haemodialysis during acute stage (OR 7.8; 95% CI 2.214-27.773) and inadequate empiric antibiotic treatment (OR 7.68; 95% CI 19.82-29.77). Admission economic cost per patient was 9,459 € for community acquired bacteriemia, 5,656 € for health care associated bacteraemia and 41,680€ for nosocomial bacteraemia. CONCLUSIONS Comorbidity, inadequate empiric antibiotic treatment and haemodialysis during acute phase are statistically significantly in our cohort of patients with bacteraemia.
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Schmitt F, Clermidi P, Dorsi M, Cocquerelle V, Gomes CF, Becmeur F. Bacterial studies of complicated appendicitis over a 20-year period and their impact on empirical antibiotic treatment. J Pediatr Surg 2012; 47:2055-62. [PMID: 23163998 DOI: 10.1016/j.jpedsurg.2012.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/17/2012] [Accepted: 04/18/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiresistant bacterial strains tend to develop, especially enterobacteriacae, in intraabdominal infections. The aim of this study was to characterize the evolution of the bacterial biota in complicated appendicitis in children over the past 20 years and their acquired resistance rates to antibiotics. MATERIALS AND METHODS All pediatric patients admitted in the emergency unit for complicated appendicitis were retrospectively reviewed during 3 periods: 1989 to 1991, 1999 to 2000, and 2009 to 2010. Results of peritoneal swabs were analyzed regarding bacterial species and resistance to antibiotics. Statistical significance was set at P < .05. RESULTS Thirty-four, 48, and 85 patients from the 3 periods, respectively, were included, with 1 to 6 bacterial strains found in each peritoneal sample. During the first period, 80% of the biota was composed of enterobacteriacae and anaerobes and then decreased to 65%, whereas streptococci levels increased from 0 to 22%. Pansusceptibility rates remained stable (17%, 16.8%, and 15.6% for the 3 periods, respectively). Piperacillin, vancomycin, ticarcillin-clavulanic acid, and fluoroquinolones were associated with increased resistance rates, unlike antibiotic associations currently used as postoperative treatments. CONCLUSION No significant increase in resistance rates of bacteriacae in complicated appendicitis in children was found over the last 20 years. Empirical antibiotherapy protocols currently recommended remain efficient on this particular biota.
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Affiliation(s)
- Françoise Schmitt
- Department of Pediatric Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
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10
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Grau S, Rebollo P, Cuervo J, Gil-Parrado S. [Pharmacoeconomic assessment of daptomycin as first-line therapy for bacteraemia and complicated skin and skin structure infections caused by gram-positive pathogens in Spain]. Rev Esp Quimioter 2011; 24:154-163. [PMID: 21947099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess the efficiency of daptomycin as firstline therapy (D) versus daptomycin as salvage therapy after vancomycin (V→D ) or linezolid (L→D) failure in gram-positive bacteraemia and complicated skin and skin-structure infections (cSSTIs). METHODS Cost-effectiveness analysis of 161 bacteraemia and 84 cSSTIs patients comparing the above mentioned therapeutic alternatives was performed using the data from 27 Spanish hospitals involved in the EUCORE study. Direct medical costs were considered. Patients were observed from the first antibiotic dose for infection until either the end of daptomycin therapy or exitus. A multivariate Monte Carlo probabilistic sensitivity analysis was applied for costs (lognormal distribution) and effectiveness (normal distribution). RESULTS In terms of effectiveness there were no statistical differences between groups but referring total costs per patient, there were significant differences. Sensitivity analysis confirmed that D dominates over L→D between 44.2%-62.1% of simulations in bacteraemia and between 48.2%-67.5% in cSSTIs. In comparison to V→D, D dominance was detected in 29.2%-33.2% of simulations in bacteraemia and between 48.2%-59.3% in cSSTIs. CONCLUSIONS Daptomycin as first-line therapy dominates over daptomycin as salvage therapy after linezolid failure both in bacteraemia and cSSTIs. Comparing daptomycin as first-line therapy with its use after vancomycin failure, in cSSTIs the former is dominant. In bacteremia daptomycin as first line therapy is as effective as daptomycin as salvage therapy after vancomycin failure and implies lower costs.
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Affiliation(s)
- S Grau
- Departamento de Farmacia del Hospital del Mar. Universitat Autònoma de Barcelona, Spain.
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Butler AM, Olsen MA, Merz LR, Guth RM, Woeltje KF, Camins BC, Fraser VJ. Attributable costs of enterococcal bloodstream infections in a nonsurgical hospital cohort. Infect Control Hosp Epidemiol 2010; 31:28-35. [PMID: 19951200 PMCID: PMC3608393 DOI: 10.1086/649020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with increased morbidity and mortality. OBJECTIVE To determine the hospital costs and length of stay attributable to VRE BSI and vancomycin-sensitive Enterococcus (VSE) BSI and the independent effect of vancomycin resistance on hospital costs. METHODS A retrospective cohort study was conducted of 21,154 nonsurgical patients admitted to an academic medical center during the period from 2002 through 2003. Using administrative data, attributable hospital costs (adjusted for inflation to 2007 US dollars) and length of stay were estimated with multivariate generalized least-squares (GLS) models and propensity score-matched pairs. RESULTS The cohort included 94 patients with VRE BSI and 182 patients with VSE BSI. After adjustment for demographics, comorbidities, procedures, nonenterococcal BSI, and early mortality, the costs attributable to VRE BSI were $4,479 (95% confidence interval [CI], $3,500-$5,732) in the standard GLS model and $4,036 (95% CI, $3,170-$5,140) in the propensity score-weighted GLS model, and the costs attributable to VSE BSI were $2,250 (95% CI, $1,758-$2,880) in the standard GLS model and $2,023 (95% CI, $1,588-$2,575) in the propensity score-weighted GLS model. The median values of the difference in costs between matched pairs were $9,949 (95% CI, $1,579-$24,693) for VRE BSI and $5,282 (95% CI, $2,042-$8,043) for VSE BSI. The costs attributable to vancomycin resistance were $1,713 (95% CI, $1,338-$2,192) in the standard GLS model and $1,546 (95% CI, $1,214-$1,968) in the propensity score-weighted GLS model. Depending on the statistical method used, attributable length of stay estimates ranged from 2.2 to 3.5 days for patients with VRE BSI and from 1.1 to 2.2 days for patients with VSE BSI. CONCLUSIONS VRE BSI and VSE BSI were independently associated with increased hospital costs and increased length of stay. Vancomycin resistance was associated with increased costs.
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Affiliation(s)
- Anne M Butler
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
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12
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You JHS, Lee GCH, So RKH, Cheung KW, Hui M. Linezolid versus Vancomycin for Prosthetic Joint Infections: a Cost Analysis. Infection 2007; 35:265-70. [PMID: 17646907 DOI: 10.1007/s15010-007-6304-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 02/26/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prosthetic joint infections (PJIs) caused by methicillin-resistant gram-positive bacteria are primarily treated by intravenous vancomycin. Linezolid, active against methicillin-resistant strains and available in oral and intravenous dosage forms, is a potential alternative to vancomycin for the treatment of PJIs. OBJECTIVE To analyze the cost of linezolid therapy (outpatient setting) and vancomycin therapy (inpatient and outpatient settings) for PJIs caused by methicillin-resistant gram-positive bacteria. METHODS A decision tree was designed to simulate the clinical outcome and healthcare resource utilization of linezolid, vancomycin by outpatient and home parenteral antimicrobial therapies (OHPAT) and vancomycin administered in inpatient setting (rehabilitation facility) for patients with PJIs caused by methicillin-resistant strains. Clinical inputs were estimated from literature and the cost analysis was conducted from the perspective of the public healthcare provider in Hong Kong. RESULTS The base-case analysis showed that the vancomycin (OHPAT) group (USD14,470 per patient) was the least costly alternative, followed by the linezolid group (USD17,877 per patient) and the vancomycin (rehabilitation) group (USD19,980 per patient) (1USD = 7.8HKD). The clinical treatment success rates of vancomycin and linezolid were influential factors. Monte Carlo 10,000 simulations showed that the vancomycin (OHPAT) group was less costly than the arms of linezolid and vancomycin (rehabilitation) 64% and 100% of the time, respectively. The linezolid group was less costly than the vancomycin (rehabilitation) group in 65%of the times. CONCLUSION Home-infusion of vancomycin therapy appears to be the least costly treatment approach for PJIs caused by methicillin-resistant gram-positive bacteria from the perspective of a Hong Kong public health organization.
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Affiliation(s)
- J H S You
- Centre for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
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Preventing catheter-related infectious complications. J Support Oncol 2007; 5:70-1. [PMID: 17348360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
The unmet medical need of emerging resistance among Gram-positive pathogens, such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and penicillin-resistant Streptococcus pneumoniae, has driven industry towards the identification and development of novel anti-Gram-positive agents. Among the newer agents are improved quinolones, a lipopeptide, an oxazolidinone and novel glycopeptides. Scientific distinctions between these drugs, which impact on the placement, usage and, ultimately, the pharmacoeconomics of several of these new agents, may lead to further consideration despite poor initial observations of minimal improvement. Key differences in the characteristics of these drugs (i.e., spectrum, activity, resistance emergence, efficacy, target, safety) provide a basis for an emerging pharmacoeconomic-based distinction between these newer anti-Gram-positive agents.
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Affiliation(s)
- Liangsu Wang
- Department of Infectious Diseases, Merck Research Laboratories, Rahway, NJ 07065, USA.
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Portolés A, Palau E, Puerro M, Vargas E, Picazo JJ. Health economics assessment study of teicoplanin versus vancomycin in Gram-positive infections. Rev Esp Quimioter 2006; 19:65-75. [PMID: 16688294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study, conducted at Hospital Clínico San Carlos, Madrid, Spain, was to compare the cost of treatment of Gram-positive infections with teicoplanin and vancomycin under normal conditions. Using a prospective observational study design for drug utilization and economic assessment, we evaluated the comparability of the sample, adverse events, features of treatment with teicoplanin/vancomycin and factors influencing the consumption of resources until the end of glycopeptide treatment or discharge (whichever occurred later) using Health System perspective. Costs were assigned using the hospital's evaluation at the time of the study. Analyses made: multivariate, sensitivity (by modifying staff or acquisition costs) and simulation of reduction of stay by early discharge in the teicoplanin group. Study participants included 201 patients who had been using teicoplanin (n=100) or vancomycin (n=101) for at least four days. Data collected daily outside morning work timetable. Costs of acquisition, administration and monitoring by course of treatment (mean+/-SD, in euros) were lower in the vancomycin group (teicoplanin euro647.62+/-euro572.75 vs. vancomycin euro378.11+/-euro225.90); when total costs (including hospital stay) were considered, no differences were found (teicoplanin euro4,432.04+/-euro3,383.46 vs. vancomycin euro4,364.44+/-euro2,734.24). Conditions of use and results were similar for both antibiotics. The economic results of acquisition, administration and monitoring were advantageous for vancomycin; when global costs of care were taken into account, these differences were not evident. Tolerability was significantly advantageous in the teicoplanin group (with regard to phlebitis and elevation of creatininemia), without differences in clinical or economic outcomes. The formulation of teicoplanin did not take advantage of its potential benefits of administration.
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Affiliation(s)
- A Portolés
- Servicios Farmacología Clínica, Hospital Clínico San Carlos, Madrid, Spain
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Grau S, Mateu-de Antonio J, Soto J, Marín-Casino M, Salas E. Pharmacoeconomic Evaluation of Linezolid Versus Teicoplanin in Bacteremia by Gram-Positive Microorganisms*. ACTA ACUST UNITED AC 2005; 27:459-64. [PMID: 16341954 DOI: 10.1007/s11096-005-1638-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare the efficiency of linezolid versus teicoplanin in the treatment of bacteremia produced by Gram-positive microorganisms through a pharmacoeconomic analysis based on clinical results obtained from a previous clinical trial. METHODS We applied an analysis of cost-effectiveness elaborated through a pharmacoeconomic model. We defined each unit of effectiveness as 'each successfully cured of infections with bacteremia.' We used the program Pharma-Decision (version Hospital 1.1) that allows to build interactive pharmacoeconomic models. Effectiveness data of both antibiotics were obtained from a published clinical trial, while resources consumed were obtained from the same source and from a consensus provided by a local expert panel. Only direct costs were included in the analysis without taking into consideration indirect costs. The perspective chosen was hospital assistance and the time horizon was set to 28 days. All costs are expressed in Euros. RESULTS Linezolid demonstrated a better clinical outcome with less associated costs compared to teicoplanin (88.5 versus 56.7% of cured patients and 5,557.04 versus 6,327.43 <euro> per treated patient, respectively), thus resulting in a lower cost-effectiveness ratio for linezolid versus teicoplanin (6,279.1 versus 11,159.5 <euro> per cured patient with a 95% CI of 5,960.2-6,510.4 and 10,865.2-12,647.3, respectively) which results in a the dominant position for linezolid. The sensitivity analysis showed that linezolid was always the most efficient option even when modifying the value of variables with higher uncertainty. CONCLUSIONS Linezolid is a more efficient option than teicoplanin because it presents higher rate of effectiveness with lower consumption of resources, thus being a dominant alternative in the treatment of Gram-positive infection with bacteremia.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.
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Abstract
Linezolid (Zyvox), the first available oxazolidinone antibacterial agent, has good activity against Gram-positive pathogens, including multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Randomised multicentre trials in patients with various types of serious Gram-positive infections showed that clinical cure rates with linezolid were similar to those with vancomycin or teicoplanin. In some subgroup analyses, which must be interpreted with a degree of caution, clinical advantages were noted for linezolid (e.g. versus vancomycin in confirmed MRSA nosocomial pneumonia and MRSA-complicated skin and soft tissue infections). Although generally well tolerated, gastrointestinal adverse effects are relatively common with linezolid and it has been associated with thrombocytopenia and myelosuppression. The oral bioavailability of linezolid is approximately 100%, thus allowing sequential intravenous-to-oral administration without changing the drug or dosage regimen. Healthcare resource use data from various countries indicate that this practical advantage translates into at least a trend towards reduced length of hospital stay compared with vancomycin, which may offset its several-fold higher acquisition cost. Modelled analyses from the US, despite some limitations, indicate that, compared with vancomycin, linezolid is associated with lower total hospitalisation costs for the treatment of patients with cellulitis and has a favourable incremental cost-effectiveness ratio of approximately US30,000 dollars per QALY gained (2001 value) for patients with ventilator-associated pneumonia. Broadly similar results have also been reported in modelled analyses from other countries. In conclusion, for patients with serious Gram-positive infections, including those caused by suspected or proven multidrug-resistant pathogens such as MRSA, linezolid is an effective and generally well tolerated therapeutic option. Linezolid is currently the only antibacterial agent with good activity against MRSA that can be administered orally (as well as intravenously). It may be particularly useful as an alternative to vancomycin in patients who have impaired renal function, poor or no intravenous access, require outpatient therapy, or who have been unable to tolerate glycopeptides. Healthcare resource use studies and pharmacoeconomic analyses generally support the use of linezolid in some subgroups of patients, although results should be interpreted with due consideration of the study limitations.
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Wilcox M, Nathwani D, Dryden M. Linezolid compared with teicoplanin for the treatment of suspected or proven Gram-positive infections. J Antimicrob Chemother 2004; 53:335-44. [PMID: 14729745 DOI: 10.1093/jac/dkh088] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The efficacy, safety and tolerability of linezolid was compared with teicoplanin in a randomized, controlled, open-label, multicentre study of 430 patients with suspected or proven Gram-positive infection. Patients received intravenous (iv) +/- oral linezolid 600 mg every 12 h (n = 215) or iv or intramuscular teicoplanin (n = 215) for up to 28 days. Clinical outcomes in the intent-to-treat (ITT) and clinically-evaluable populations and microbiological success rates in microbiologically evaluable patients were assessed at follow-up (test of cure). Investigator assessed clinical cure rates at end of treatment (EOT) in ITT patients treated with linezolid (95.5%) were superior to those of teicoplanin (87.6%) for all infections combined, indicating a 7.9% statistically significant treatment advantage for linezolid (P = 0.005, 95% CI: 2.5, 13.2). Clinical cure rates by baseline diagnosis were consistently higher at EOT for the linezolid versus teicoplanin groups with skin and soft tissue infection (96.6% versus 92.8%), pneumonia (96.2% versus 92.9%) and bacteraemia (88.5% versus 56.7%). The 31.8% treatment advantage in bacteraemic patients (but not for those seen in the other infection categories) for linezolid-treated patients was statistically significant (P = 0.009, 95% CI: 10.2, 53.4). Bacterial eradication rates for linezolid exceeded those of teicoplanin for all infection sites combined but this did not reach statistical significance (81.9% versus 69.8%, respectively; P = 0.056). Adverse event rates were similar between the treatment groups, were mild to moderate in severity, and resolved quickly following treatment. The linezolid group experienced a higher incidence of drug related adverse events (30% versus 17%; P = 0.002), and notably of gastrointestinal effects (13.0% versus 1.9%, P = 0.001). However, antibiotic discontinuation rates as a result of drug related adverse events were similar (4.7% in the linezolid group versus 3.7%). Linezolid was clinically superior to teicoplanin in the treatment of Gram-positive infections.
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Affiliation(s)
- Mark Wilcox
- Department of Microbiology, Leeds General Infirmary & University of Leeds Teaching Hospitals, Old Medical School, Leeds LS1 3EX.
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Solomkin JS, Bjornson HS, Cainzos M, Dellinger EP, Dominioni L, Eidus R, Faist E, Leaper D, Lee JT, Lipsett PA, Napolitano L, Nelson CL, Sawyer RG, Weigelt J, Wilson SE. A consensus statement on empiric therapy for suspected gram-positive infections in surgical patients. Am J Surg 2004; 187:134-45. [PMID: 14706605 DOI: 10.1016/j.amjsurg.2003.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multidrug resistance among gram-positive pathogens in tertiary and other care centers is common. A systematic decision pathway to help select empiric antibiotic therapy for suspected gram-positive postsurgical infections is presented. DATA SOURCES A Medline search with regard to empiric antibiotic therapy was performed and assessed by the 15-member expert panel. Two separate panel meetings were convened and followed by a writing, editorial, and review process. CONCLUSIONS The main goal of empiric treatment in postsurgical patients with suspected gram-positive infections is to improve clinical status. Empiric therapy should be initiated at the earliest sign of infection in all critically ill patients. The choice of therapy should flow from beta-lactams to vancomycin to parenteral linezolid or quinupristin-dalfopristin. In patients likely to be discharged, oral linezolid is an option. Antibiotic resistance is an important issue, and in developing treatment algorithms for reduction of resistance, the utility of these new antibiotics may be extended and reduce morbidity and mortality.
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Affiliation(s)
- Joseph S Solomkin
- Division of Trauma and Critical Care, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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López H, Li JZ, Balan DA, Willke RJ, Rittenhouse BE, Mozaffari E, Vidal G, Zitto T, Tang T. Hospital resource use and cost of treatment with linezolid versus teicoplanin for treatment of serious gram-positive bacterial infections among hospitalized patients from South America and Mexico: results from a multicenter trial. Clin Ther 2003; 25:1846-71. [PMID: 12860502 DOI: 10.1016/s0149-2918(03)80173-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Linezolid is a novel oxazolidinone antibiotic that is effective for the treatment of gram-positive bacterial infections. The oral formulation has the potential to reduce length of stay (LOS) when used as a substitute for parenteral glycopeptide antibiotics. In a recent multinational trial comparing linezolid (i.v. followed by oral administration) with teicoplanin (i.v. alone or switched to i.m. administration), linezolid was found to have better efficacy (P = 0.005) and similar safety for treating serious gram-positive infections. OBJECTIVE The purpose of this study was to compare hospital resource use (primarily LOS) and cost of treatment between linezolid and teicoplanin for hospitalized patients with serious gram-positive infections in South America and Mexico using data from the multinational trial. METHODS In a multinational, Phase IIIb, open-label, comparator-controlled trial, data were collected from hospitalized patients in centers in 6 South America can countries and Mexico with suspected or confirmed serious gram-positive infections. Patients were randomly assigned to receive i.v. linezolid 600 mg BID (for the entire treatment period [7-28 days] or switched to oral linezolid 600 mg BID) or i.v. teicoplanin (for the entire treatment period or switched to i.m. teicoplanin) dosed per approved prescription information. Data on direct medical resource utilization were collected for each patient, including duration and doses of study medication, location of hospitalization and LOS, comedications, tests and procedures, and outpatient service usage. Unit costs for the medical resources were obtained from secondary sources. RESULTS A total of 203 patients (97 treated with linezolid and 106 treated with teicoplanin) were enrolled from these 7 countries. The unadjusted results showed that compared with teicoplanin, patients treated with linezolid had a 3.1-day shorter mean i.v. antibiotic treatment duration (P < 0.001), a 2.0- to 2.2-day shorter median and mean LOS (P = 0.03), and a 311 US dollars lower mean total cost of treatment (P = NS). After controlling for age, race, sex, site of infection, inpatient location when the antibiotic treatment started, number of historical and current comorbidities, and whether the patient had a diagnosis of systemic inflammatory response syndrome or sepsis, the multivariate adjusted results were similar to the unadjusted results. The linezolid group had a 1.6-day shorter adjusted LOS or 66% greater odds of early discharge (P = 0.049) and a 335 US dollars lower adjusted mean total cost of treatment (P = NS). CONCLUSION Linezolid was associated with shorter LOS and duration of IV antibiotic treatment than teicoplanin for serious gram-positive infections in the population studied. Linezolid therapy has the potential to reduce the total cost of treatment.
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Affiliation(s)
- Blair Capitano
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA
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Abstract
PURPOSE The goal of this study was to determine the causes of increased post-arthroscopy surgical site infections (SSIs) and to define risk factors for infection. TYPE OF STUDY Outbreak investigation and case control study at a university-affiliated community hospital from 1994 to 1996, with surveillance through 1999. METHODS Demographic, clinical, and microbiological data were collected on 27 post-arthroscopy SSIs from 1994 through 1999. Risk factors for SSI were identified by case-control analysis and presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Initial investigation revealed an increased annual rate of post-arthroscopy SSIs in 1995 (1.3%). Infection control deficiencies were identified, and feedback was provided to surgeons and staff. Instrument sterilization was standardized, flash sterilization prohibited, and preoperative shaving discouraged. Case-control analysis of 10 cases (from 1994 to 1996) found a statistically significant increase in risk of SSI with intra-articular corticosteroid joint injection (OR, 9.33; 95% CI, 1.6 to 64.9); other risk factors did not reach statistical significance. SSI rates dropped after feedback and education (0.34% in 1996). Continued surveillance revealed 2 smaller outbreaks, in December 1997 (1997 rate, 1.13%) and September 1998 (1998 rate, 1.09%). Case-control analysis of the 17 cases occurring in 1997 through 1999 was also performed. The 1997 outbreak appeared to be related to preoperative razor shaving (P =.003), which was then prohibited by hospital policy. One scrub nurse was also associated with 75% of these cases, which were culture-positive for coagulase-negative Staphylococcus. The cases in the 1998 outbreak shared prolonged procedure duration and conversion to arthrotomy. Of 27 cases, 24 required repeat hospitalization and repeat surgery, at an average excess cost of $9,154.84 per case. All received prolonged courses of intravenous or oral antibiotics. CONCLUSIONS Post-arthroscopy SSIs are associated with significant morbidity and cost. Although small numbers make finding statistical significance difficult in case-control studies, infection control and CDC-recommended interventions can lower SSI rates. Careful definitions, ongoing surveillance, and long-term follow-up are helpful in reporting results of infection control interventions.
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Affiliation(s)
- Hilary M Babcock
- Infectious Disease Division, Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
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Abstract
BACKGROUND The health and economic impact of vancomycin-resistant enterococci has not been quantified. METHODS A retrospective matched cohort study was conducted comparing the outcomes of patients with vancomycin-resistant enterococci (cases) with those of control subjects matched for length of hospital stay until inclusion in the cohort, hospital location, and calendar date. The propensity to be a vancomycin-resistant enterococci case was modeled based on patient characteristics, and included in multivariable models to adjust for confounding. Analyses included the following: (1) conditional logistic regression for mortality, surgery, intensive care unit admission, and discharge to long-term care; (2) linear regression for the logarithm of cost; and (3) accelerated failure time model for length of stay. RESULTS A total of 233 cases were compared with 647 controls. Groups were similar in age (mean, 62 years), sex (female, 47%), and length of stay before inclusion in the cohort (mean, 8.1 days), but differed in primary diagnosis and comorbidities, past infection or colonization with methicillin sodium-resistant Staphylococcus aureus or Clostridium difficile, and treatment with cephalosporins or metronidazole. These variables were included in the propensity score, which had good to excellent prediction. Outcomes for cases vs controls and adjusted risks (relative risks [RRs]) were as follows: (1) case fatality rate, 17% vs 6% (RR, 2.13; P =.04); (2) length of stay after inclusion in the cohort, 15.1 vs 8.5 days (RR, 1.73; P<.001); (3) hospital costs, $52 449 vs $31 915 (RR, 1.40; P<.001); (4) surgery after inclusion in the cohort, 18% vs 10% (RR, 2.74; P =.001); (5) intensive care unit admission after inclusion in the cohort, 25% vs 14% (RR, 3.47; P<.001); and (6) transfer to an institution, 51% vs 35% (RR, 2.01; P =.001). CONCLUSION Compared with a matched hospital population, a population with vancomycin-resistant enterococci was associated with severe adverse outcomes: increased mortality, morbidity, and costs.
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Affiliation(s)
- Yehuda Carmeli
- Division of Infectious Diseases, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 62749, Israel.
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24
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Mayhall CG. Control of vancomycin-resistant enterococci: it is important, it is possible, and it is cost-effective. Infect Control Hosp Epidemiol 2002; 23:420-3. [PMID: 12186205 DOI: 10.1086/502078] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Muto CA, Giannetta ET, Durbin LJ, Simonton BM, Farr BM. Cost-effectiveness of perirectal surveillance cultures for controlling vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002; 23:429-35. [PMID: 12186207 DOI: 10.1086/502080] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several hospitals opting not to use active surveillance cultures to identify carriers of vancomycin-resistant Enterococcus (VRE) have reported that adoption of other parts of the Centers for Disease Control and Prevention guideline for controlling VRE has had little to no impact. Because use of surveillance cultures and contact isolation controlled a large outbreak at this hospital, their costs were estimated for comparison with the excess costs of VRE bacteremias occurring at a higher rate at a hospital not employing these measures. SETTING Two university hospitals. METHODS Inpatients deemed high risk for VRE acquisition at this hospital underwent weekly perirectal surveillance cultures. Estimated costs of cultures and resulting isolation during a 2-year period were compared with the estimated excess costs of more frequent VRE bacteremias at another hospital of similar size and complexity not using surveillance cultures to control spread throughout the hospital. RESULTS Of 54,052 patients admitted, 10,400 had perirectal swabs taken. Cultures and isolation cost an estimated $253,099. VRE culture positivity was limited to 193 (0.38%) and VRE bacteremia to 1 (0.002%) as compared with 29 bacteremias at the comparison hospital. The estimated attributable cost of VRE bacteremia at the comparison hospital of $761,320 exceeded the cost of the control program at this hospital by threefold. CONCLUSIONS The excess costs of VRE bacteremia may justify the costs of preventive measures. The costs of VRE infections at other body sites, of deaths from untreatable infections, and of dissemination of genes for vancomycin resistance also help to justify the costs of implementing an effective control program.
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Affiliation(s)
- Carlene A Muto
- University of Virginia Health System, Charlottesville 22908, USA
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[symbol: see text]Quinupristin + dalfopristin for infections. Drug Ther Bull 2002; 40:15-6. [PMID: 11892373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Quinupristin + dalfopristin* (Synercid -- Aventis Pharma Ltd) is a new combination antibacterial product licensed for treating patients with a variety of Gram-positive infections. Here we assess its place in clinical practice.
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Webb M, Riley LW, Roberts RB. Cost of hospitalization for and risk factors associated with vancomycin-resistant Enterococcus faecium infection and colonization. Clin Infect Dis 2001; 33:445-52. [PMID: 11462178 DOI: 10.1086/321891] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2000] [Revised: 03/07/2001] [Indexed: 11/03/2022] Open
Abstract
The increase in costs of hospitalization for patients with drug-resistant infection may be associated with drug resistance itself or with the severity of the underlying illness that predisposes patients to acquire the drug-resistant infection. To address this issue, risk factors and cost of hospitalization were compared for patients infected or colonized with vancomycin-susceptible Enterococcus faecium (VSEF) or vancomycin-resistant E. faecium (VREF) in a large tertiary-care hospital in New York City. From January 1995 through December 1996, 157 patients with VSEF and 262 patients with VREF were identified. CMI (case-mix index) was assigned to each patient as a measure of severity of illness, with a CMI of 1 considered to represent illness of average severity. For all patients who were assigned a CMI of <3, the cost per day of hospitalization for patients with VREF was significantly greater than that for patients with VSEF. However, for patients with a CMI of >3, there was no difference between cost of hospitalization for patients with VREF and that for patients with VSEF. These observations indicate that, although vancomycin resistance is associated with an increased cost of hospitalization for less severely ill patients with VREF, patients with severe underlying illness, regardless of vancomycin resistance, incur similar hospitalization costs.
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Affiliation(s)
- M Webb
- Division of Infectious Diseases, School of Public Health, University of California, Berkeley, CA, USA
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Montecalvo MA, Jarvis WR, Uman J, Shay DK, Petrullo C, Horowitz HW, Wormser GP. Costs and savings associated with infection control measures that reduced transmission of vancomycin-resistant enterococci in an endemic setting. Infect Control Hosp Epidemiol 2001; 22:437-42. [PMID: 11583213 DOI: 10.1086/501931] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting. DESIGN Evaluation of costs and savings, using historical control data. SETTING Adult oncology unit of a 650-bed hospital. PARTICIPANTS Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients. METHODS Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model. RESULTS The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings. CONCLUSION The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least six to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.
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Affiliation(s)
- M A Montecalvo
- Division of Infectious Diseases, New York Medical College, Valhalla 10595, USA
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McAuley L. Linezolid for the treatment of serious gram-positive infections. Issues Emerg Health Technol 2001:1-6. [PMID: 11902223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- L McAuley
- Canadian Coordinating Office for Health Technology Assessment
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Dimitrov A, P'nevska M, Dikov I, Nikolov A, Kostov I. [Prophylaxis with Tercef of infection-related complications following cesarean section]. Akush Ginekol (Sofiia) 2001; 41 Suppl 4:15-8. [PMID: 11519314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Elting LS, Rubenstein EB, Rolston K, Cantor SB, Martin CG, Kurtin D, Rodriguez S, Lam T, Kanesan K, Bodey G. Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care. J Clin Oncol 2000; 18:3699-706. [PMID: 11054443 DOI: 10.1200/jco.2000.18.21.3699] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether antibiotic regimens with similar rates of response differ significantly in the speed of response and to estimate the impact of this difference on the cost of febrile neutropenia. METHODS The time point of clinical response was defined by comparing the sensitivity, specificity, and predictive values of alternative objective and subjective definitions. Data from 488 episodes of febrile neutropenia, treated with either of two commonly used antibiotics (coded A or B) during six clinical trials, were pooled to compare the median time to clinical response, days of antibiotic therapy and hospitalization, and estimated costs. RESULTS Response rates were similar; however, the median time to clinical response was significantly shorter with A-based regimens (5 days) compared with B-based regimens (7 days; P =.003). After 72 hours of therapy, 33% of patients who received A but only 18% of those who received B had responded (P =.01). These differences resulted in fewer days of antibiotic therapy and hospitalization with A-based regimens (7 and 9 days) compared with B-based regimens (9 and 12 days, respectively; P <.04) and in significantly lower estimated median costs ($8,491 v $11,133 per episode; P =.03). Early discharge at the time of clinical response should reduce the median cost from $10,752 to $8,162 (P <.001). CONCLUSION Despite virtually identical rates of response, time to clinical response and estimated cost of care varied significantly among regimens. An early discharge strategy based on our definition of the time point of clinical response may further reduce the cost of treating non-low-risk patients with febrile neutropenia.
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Affiliation(s)
- L S Elting
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Palau J, Picón I, Aznar E, Climent MA, Máiquez J. [Cost of antibiotic therapy in neutropenic patients undergoing peripheral blood stem cell transplantation for breast cancer]. Rev Esp Quimioter 2000; 13:193-8. [PMID: 10918094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The increase in pharmaceutical costs, especially for expensive procedures such as bone marrow transplants, has led to the study of the economic impact of febrile neutropenia in peripheral blood stem cell transplantation (PBSCT). We analyzed 89 consecutive patients with breast cancer who underwent PBSCT. All patients developed febrile neutropenia and were administered an empirical intravenous regimen based on the combination of piperacillin-tazobactam and amikacin. We analyzed the direct costs of this treatment and grouped them into drug acquisition cost, administration costs (cost of the additional material), and preparation costs (time employed for the preparation and administration of the drug). We found that the overall cost was $1,110, 65% of which corresponded to the initial therapy and the rest (35%) to the use of additional antibiotics. This higher cost was especially related to the use of vancomycin or teicoplanin (50%). The acquisition costs accounted for 90% of the overall treatment costs. Thirty-six patients (40%) did not need additional antibiotics and the cost in this group was less ($663). We concluded that knowledge of the costs of pharmacological therapy for infection in PBSCT is indispensable for the appropriate development of treatment units, especially in terms of optimizing resources and comparing different therapeutic or prophylactic approaches.
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Affiliation(s)
- J Palau
- Unidad de Trasplante de Médula Osea
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Report from the Catalan Agency for Health Technology Assessment (CAHTA). Review of the scientific evidence of the clinical and economic implications of resistance of enterococcus to vancomycin. Int J Technol Assess Health Care 1999; 15:767-9. [PMID: 10645118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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35
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Abstract
The rapid emergence of antibiotic resistance in hospitals and the community, particularly amongst Gram-positive cocci, has not been paralleled by adequate understanding of the true clinical and economic impact of infection with resistant pathogens. Furthermore, the development of novel compounds to combat this threat has been slow until recently when a number of new agents, some with a unique structure and mode of action (e.g. linezolid), are now being developed for clinical use. This paper aims to outline (1) the costs associated with infection by a resistant organism (2) the pharmacoeconomic arguments when considering a new drug and (3) the key decisions when evaluating a new drug such as linezolid, for inclusion in a formulary or policy with particular reference to the treatment of serious Gram-positive infections.
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Affiliation(s)
- D Nathwani
- Infection and Immunodeficiency Unit, Tayside University Hospitals NHS Trust, Dundee, UK
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Zuckerman RA, Steele L, Venezia RA, Tobin EH. Undetected vancomycin-resistant Enterococcus in surgical intensive care unit patients. Infect Control Hosp Epidemiol 1999; 20:685-6. [PMID: 10530646 DOI: 10.1086/501565] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The rates of vancomycin-resistant Enterococcus (VRE) in a high-risk population were investigated prospectively using an active surveillance method. The costs of conducting active surveillance were calculated. Among the 10 patients found to have VRE, routine cultures identified 3 (30%); thus, 70% of the VRE-colonized patients would have gone undetected in the absence of active surveillance. The total cost for 5 weeks of active surveillance was $2,234. Although active surveillance identified a high rate of VRE-colonized patients who otherwise may not have been identified, it remains to be determined if the additional costs are justified and result in reduced transmission.
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Affiliation(s)
- R A Zuckerman
- Albany Medical Center, Albany Medical College, New York, USA
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Caldwell JW, Singh S, Johnson RH. Clinical and economic evaluation of subsequent infection following intravenous ciprofloxacin or imipenem therapy in hospitalized patients with severe pneumonia. J Antimicrob Chemother 1999; 43 Suppl A:129-34. [PMID: 10225583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
A recent multicentre clinical study evaluated the safety and efficacy of i.v. ciprofloxacin therapy compared with imipenem-cilastatin in hospitalized patients with severe pneumonia. Monotherapy with i.v. ciprofloxacin was at least equivalent to imipenem in terms of bacteriological eradication and clinical response. In a single-centre, retrospective, post-therapy evaluation of persistent and subsequent infection, the incidence of gram-negative infections and associated costs were compared. The main elements of the economic analysis included costs of additional antimicrobial therapy and hospitalization. Thirty-two patients were randomized into the study, of whom 27 were efficacy-valid. The 13 patients randomized into the ciprofloxacin group were not significantly different from the 14 patients in the imipenem group in terms of clinical parameters. Clinical cure occurred in ten of 13 patients (77%) in the ciprofloxacin group and in seven of 14 (50%) in the imipenem group. Bacteriological eradication was achieved in 11 of 13 (85%) ciprofloxacin-treated and eight of 14 (57%) imipenem-treated patients. Five of 13 (38%) patients in the ciprofloxacin group and nine of 14 (64%) in the imipenem group experienced persistent or subsequent infection requiring post-treatment antimicrobials. In these five ciprofloxacin patients, three had cultures with gram-positive organisms only and two had cultures with both gram-positive and gram-negative organisms. In the nine imipenem-treated patients requiring post-study antimicrobials, all had gram-negative bacteria and three also had gram-positive organisms. The incidence of subsequent gram-negative infection in the two groups (15% vs 64%) was significantly different (P < 0.05). Pseudomonas aeruginosa was isolated from seven patients in the imipenem group but only one in the ciprofloxacin group (P < 0.05). Subsequent costs for post-therapy antimicrobials and hospital stay while receiving study and post-study drug therapy were evaluated; the cost per patient cure was US$29,000 for ciprofloxacin and US$76,000 for imipenem. Initial treatment of severe pneumonia with ciprofloxacin resulted in significantly less subsequent gram-negative infection and was associated with substantially lower curative costs.
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Affiliation(s)
- J W Caldwell
- UCLA Department of Medicine, Kern Medical Center, Bakersfield, CA 93305, USA.
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Krupova Y, Novotny J, Sabo A, Mateicka F, Krcmery V. Aetiology, cost of antimicrobial therapy and outcome in neutropenic patients who developed bacteraemia during antimicrobial prophylaxis: a case-control study. Int J Antimicrob Agents 1998; 10:313-6. [PMID: 9916907 DOI: 10.1016/s0924-8579(98)00054-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sixty four episodes of bacteraemia that appeared during antimicrobial prophylaxis with an oral quinolone plus an azole in neutropenic cancer patients were compared with 128 cases of bacteraemia in a cohort of controls matched for age, sex, underlying disease, neutropenia and vascular catheter in situ to assess differences in aetiology, cost of therapy and outcome. Patients who received prophylaxis had breakthrough bacteraemias of a different aetiology compared with the control group: they had significantly fewer multiply-resistant strains (21.9 vs. 51.5, P < 0.04) and a longer afebrile neutropenic period (9.55 days vs. 4.1, P < 0.001). Patients who received prophylaxis also had bacteraemias that were significantly more frequently caused by viridans streptococci (9.4%, vs. 1.7%, P < 0.01), enterococci (15.6% vs. 7.2%, P < 0.05) and Stenotrophomonas maltophilia (17.2% vs. 3.4%, P < 0.01). The cost of antimicrobial therapy per case (37401 SKK (1091 USD) vs. 31808 SKK (899 USD), P < 0.05) was also significantly higher in cases than controls; however, the number of administered antibiotics (4.18 vs. 3.21 per case, P = NS) was similar in both groups. There were no differences in outcome between both groups. However patients who received prophylaxis had significantly longer periods of afebrile neutropenia (9.55 days vs. 4.1, P < 0.001) and bacteraemia developed later than in controls. Also, the incidence of polymicrobial bacteraemia caused by multiresistant strains was lower among cases (21.9 vs. 51.5, P < 0.04).
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Affiliation(s)
- Y Krupova
- Department of Pharmacology, St. Elizabeth Cancer Institute, Bratislava, Slovakia
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Abstract
Febrile neutropenia is a changing syndrome which requires periodic updates as our armamentarium against this condition improves, and the characteristics of the pathogens change. In addition, cost of therapy has become a major issue when designing therapeutic strategies. This article reviews the basis of the current therapeutic approaches to febrile neutropenia, and this information is used to propose an algorithm for the management of this condition taking into consideration, in addition to these medical aspects, cost-effectiveness.
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Affiliation(s)
- J Klastersky
- Service de Médecine, H.J. Tagnon, Institut Jules Bordet, Brussells, Belgium
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Mariutin PV, Mikhaĭlovich DV, Uchvatkin VG, Kravets SG. [Carbapenems (thienam and Meronem). Their clinical and economic efficacy]. Anesteziol Reanimatol 1998:20-2. [PMID: 9770812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors describe 229 cases of carbapenem use in intensive care wards. Tienam was used in 205 cases since 1993, meronem in 24 cases since 1996. There were 149 men and 80 women aged 15-76 years (mean age 46.4 +/- 0.7 years). Carbapenemes were administered by 5-7-day courses in a daily dose of 2-6 g (2-4 g for tienam and 2-6 g for meronem). Carbapenemes were administered as monotherapy; in 196 cases nisoral was added to antibiotic therapy starting from day 3 as an antimycotic agent. Bacteriological studies were carried out in 367 patients (413 inoculations). Sensitivity of cultured microflora to disks with tienam (329 tests) and meronem (97 tests) showed their high activity towards gram-positive and gram-negative flora. The results were less demonstrative in cerebral abscesses, which is explained by specific pharmacokinetics of tienam. Analysis of the cost/efficacy ratio confirmed the economic efficacy of this group of drugs.
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Daumal F, Etienne C, Votte P, Bou P, Canarelli B, Desablens F, Schmit JL, Eb F. [Direct cost of antibiotic therapy prescribed for nosocomial bacteremia. Prospective study during 6 months at a CHU (University Hospital Center)]. Pathol Biol (Paris) 1998; 46:470-5. [PMID: 9769884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A six-month prospective study of costs associated with antimicrobial therapy in nosocomial bacteremia was conducted from November 1, 1995 to April 30, 1996 in a 1837-bed teaching hospital, with the help of the hospital pharmacists and hospital hygiene unit. Only the costs due to the antimicrobials themselves were taken into account. A total of 238 cases of nosocomial bacteremia occurred during the study period. The total direct cost of antimicrobial therapy was 444,931 French francs (FF), i.e., 6.8% of total expenditures for antimicrobials. Mean cost per case was 1869 FF, and was 2.6-fold higher in the 21 patients with bacteremia due to more than one organism (P = 0.03). CAses with an identifiable portal of entry contributed 75% of the total cost. Portals of entry associated with the highest cost included central venous lines (103,928 FF) and urinary tract infections (50,810 FF). Although 20% of nosocomial bacteremias due to coagulase-negative staphylococci did not lead to antimicrobial therapy, the remaining 80% contributed 40.8% of the total cost, followed by nosocomial bacteremias due to Escherichia coli with 19.7% of the total cost. Thirty-seven patients (15.5%) did not receive specific antimicrobial therapy, for the following reasons: death before treatment initiation, transfer to another hospital, antimicrobial therapy initiated earlier for another infection elsewhere in the body due to a different organism, or other form of treatment. The results of this study highlight the need for prevention.
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Affiliation(s)
- F Daumal
- Unité d'Hygiène Hospitalière et Microbiologie, Hôpital Nord CHU, Amiens, France
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Hoffman WW, Docken L. Managed care and the enterococcus. S D J Med 1998; 51:125-6. [PMID: 9577691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Arnow P. Cost control of therapy for i.v. catheter infections. Hosp Formul 1993; 28 Suppl 1:23-7. [PMID: 10123834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Intravenous catheter sepsis is an important challenge for physicians because it is associated with a high incidence of complications, and treatment can be very costly. Significant complications occur in about 25% of cases and include septic shock, suppurative thrombophlebitis, metastatic infection, and endocarditis. The risk of such complications is increased when catheter removal or appropriate antibiotic therapy is delayed, when Staphylococcus aureus is the pathogen, and probably when a prosthetic heart valve or pulmonary artery catheter is present. The optimum duration of antibiotic therapy for intravenous catheter sepsis has not been established and depends on the pathogen and on the presence of other risk factors for complications. A treatment duration of 1 week may be adequate for pathogens, such as coagulase-negative staphylococci or Candida, that are unlikely to cause complications, while > or = 2 weeks of antibiotic therapy is warranted for S aureus. Recent approaches that may help to reduce costs include shortening the duration of parenteral antibiotic treatment either by giving oral agents for part of the treatment period or by using a synergistic combination of antibiotics. Also, for infections in subcutaneously tunneled catheters, intraluminal administration of small volumes of highly concentrated antibiotics often is an effective alternative to prolonged systemic antibiotic therapy.
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Affiliation(s)
- P Arnow
- University of Chicago Hospital, IL 60637
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Craven PC. Treating bone and joint infections with teicoplanin: hospitalization vs outpatient cost issues. Hosp Formul 1993; 28 Suppl 1:41-5. [PMID: 10123838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The relative cost of outpatient parenteral antibiotic treatment of bone and joint infections with the investigational drug teicoplanin was compared with the cost of inpatient treatment. A private practice infectious disease group used teicoplanin to treat 49 patients (53 treatment courses) with bone and joint infections. The outpatient treatment program "saved" $403,680 compared with inpatient treatment, based on per diem reimbursements of $700 for inpatient treatment and $220 for outpatient treatment. Any cost analysis should be interpreted carefully because accurate calculation of outpatient treatment savings requires distinguishing among actual costs, charges, and reimbursements. In addition, there may be hidden costs related to lack of efficacy, toxicity, or litigation. Consideration should also be given to whoever is the beneficiary of the savings. Is it the indemnity insurance company, the provider, or the patient? Specific characteristics of the treatment, including ease of use, effectiveness, and monitoring requirement, may affect the savings. Our study showed that teicoplanin allows once-daily dosing, is easily administered, is generally efficacious, and has minimum requirements for blood level monitoring. These characteristics improve the cost effectiveness of using the drug in an outpatient treatment program.
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Affiliation(s)
- P C Craven
- Physicians' Medical Center, Tacoma, WA 98405
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46
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Rubinstein E. Cost implications of home care on serious infections. Hosp Formul 1993; 28 Suppl 1:46-50. [PMID: 10123839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
More than 250,000 Americans will receive home IV drug therapy this year. Antibiotics will account for two-thirds of this care. Over 60% of infections treated at home are caused by gram-positive cocci, with staphylococci accounting for approximately 24% of the pathogens. Bone and joint infections represent the most common diagnoses among patients receiving parenteral antibiotics at home, and many of the infections treated at home were initially acquired in the hospital. The most common serious complications of coronary bypass surgery, the most frequently performed operation in many hospitals, are sternal wound infections are methicillin-resistant The major pathogenic causes of these infections are methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. These complications are usually treated with prolonged inpatient IV therapy and surgery. In a study in which patients with sternal wound infections or mediastinitis secondary to coronary bypass surgery were treated with teicoplanin, preliminary results showed that the mean postoperative hospital stay was decreased by more than 7 days compared with patients receiving other types of antibiotic therapy. This was accomplished by changing from intravenous to intramuscular therapy as soon as the patient became stabilized and then discharging the patient after an additional 2 days to complete intramuscular therapy at home. In addition to enhancing the quality of life for the patient by allowing early hospital discharge and early ambulation, home therapy offers the additional benefits of decreasing the risk of cross infection to other patients, as well as to the already infected patient.
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Affiliation(s)
- E Rubinstein
- Tel Aviv University, Sackler School of Medicine, Tel Hashomer, Israel 52621
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Economic challenges of gram-positive infection. Symposium held in Florence, Italy, Spring 1992. Hosp Formul 1993; 28 Suppl 1:5-68. [PMID: 10183830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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