Incremental costs of hospital-acquired infections in COVID-19 patients in an adult intensive care unit of a tertiary hospital from a low-resource setting.

BACKGROUND: Hospital-acquired infections (HAIs) are a global public health problem and put patients at risk of complications, including death. HAIs increase treatment costs, but their financial impact on Serbia's healthcare system is unknown. Our goal was to assess incremental costs of HAIs in a tertiary care adult intensive care unit (ICU) that managed COVID-19 patients. METHODS: A retrospective study from March 6th to December 31st, 2020 included patients with microbiologically confirmed COVID-19 (positive rapid antigen test or real-time polymerase chain reaction) treated in the ICU of the Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia. Demographic and HAI-specific data acquired in our ICU were collected, including total and stratified medical costs (services, materials, laboratory testing, medicines, occupancy costs). Median total and stratified costs were compared in relation to HAI acquisition. Linear regression modelling was used to assess incremental costs of HAIs, adjusted for age, biological sex, prior hospitalisation, Charlson Comorbidity Index (CCI), and Glasgow Coma Scale (GCS) on admission. Outcome variables were length of stay (LOS) in days and mortality. RESULTS: During the study period, 299 patients were treated for COVID-19, of which 214 were included. HAIs were diagnosed in 56 (26.2%) patients. Acinetobacter spp. was the main pathogen in respiratory (38, 45.8%) and bloodstream infections (35, 42.2%), the two main HAI types. Median total costs were significantly greater in patients with HAIs (€1650.4 vs. €4203.2, p < 0.001). Longer LOS (10.0 vs. 18.5 days, p < 0.001) and higher ICU mortality (51.3% vs. 89.3%, p < 0.001) were seen if HAIs were acquired. Patients with ≥ 2 HAIs had the highest median total costs compared to those without HAIs or with a single HAI (€1650.4 vs. €3343.4 vs. €7336.9, p < 0.001). Incremental costs in patients with 1 and ≥ 2 HAIs were €1837.8 (95% CI 1257.8-2417.7, p < 0.001) and €5142.5 (95% CI 4262.3-6022.7, p < 0.001), respectively. CONCLUSIONS: This is the first economic evaluation of HAIs in Serbia, showing significant additional costs to our healthcare system. HAIs prolong LOS and influence ICU mortality rates. Larger economic assessments are needed to enhance infection control practices.

Impact of atopic dermatitis on the quality of life of children and their families.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on the quality of life (QoL). This study aims to evaluate the impact of AD on the QoL of children and their parents and to identify predictors affecting their QoL. METHODS: The cross-sectional study was conducted in Montenegro. It included 200 children with AD aged 5-16 years and their parents. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children's Dermatology Life Quality Index (CDLQI) and the Dermatitis Family Impact (DFI) questionnaire. RESULTS: The mean CDLQI score of the children affected by AD was 17.11 and the mean DFI score of their parents 19.86. There was a significant correlation between AD severity score assessed by a doctor (TIS) and both CDLQI and DFI scores (r=0.53 and r=0.27, respectively). A moderate positive correlation was observed between the QoL of children with AD and QoL of their parents (r=0.53). According to multiple linear regression, more impaired QoL of affected children was associated with more severe AD, younger parent's age and their lower educational level. Poorer QoL of parents was associated with female sex, younger age of children, more severe AD, lower educational level of parents and absence of a family history of atopic disease. CONCLUSIONS: The present study confirmed that AD has a large negative impact on QoL of both patients with AD and their families. More impaired QoL was associated with more severe AD.

Sulfur dioxide and exacerbation of allergic respiratory diseases: A time-stratified case-crossover study.

BACKGROUND: Strong epidemiological evidence suggests that air pollution plays a significant role in the exacerbation of allergic respiratory diseases. This study aimed to assess the potential relationship between daily levels of sulfur dioxide (SO2) and emergency department (ED) visits for allergic diseases. MATERIALS AND METHODS: Data regarding ED visits for allergic respiratory diseases were routinely collected from the EDs in the Zlatibor district, and the General Hospital, Uzice. The daily average concentrations of SO2 were obtained from the regional automatic air quality monitoring stations. All data were collected from June 2012 to July 2014. A time-stratified case-crossover design was used. Crude odds ratios (ORs) and ORs adjusted for weather conditions were calculated using conditional logistic regression. RESULTS: Statistically significant associations were seen between 0-day lagged exposure to SO2 and ED visits for all allergic diseases (OR = 1.62; 95% confidence interval [CI]: 1.05-2.48; P = 0.028) and between 2-day lagged exposure to SO2 and ED visits for asthma with allergic rhinitis (OR = 2.00; 95% CI: 1.03-3.88; P = 0.042). These results were adjusted for temperature, temperature2, and humidity. CONCLUSION: Our results suggest that short-term exposure to SO2 conferred an increased risk of ED visits for allergic respiratory diseases, particularly for asthma with concomitant allergic rhinitis.

Quality of life in infants with atopic dermatitis and their families.

INTRODUCTION: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, with a significant effect on quality of life (QoL). AIM: To evaluate the impact of AD on QoL of Montenegrin infants and their parents and to identify predictors affecting their QoL. MATERIAL AND METHODS: The cross-sectional study was conducted between August 2017 and July 2018 and included 186 infants with AD aged 0-4 years and their parents. The severity of disease was measured by the Three-Item Severity (TIS) score, while QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Dermatitis Family Impact (DFI) questionnaire. RESULTS: The mean overall scores were 14.72 for IDQOL and 17.78 for DFI. The positive correlation was observed between AD severity and both the IDQOL and DFI scores (r = 0.61, p < 0.001 and r = 0.67, p < 0.001, respectively). The highest-scoring IDQOL items were "itching and scratching", and "child's mood". Poorer infants' QoL was associated with more serious AD (B = 2.56; 95% confidence interval (CI): 2.08-3.04), concomitant atopic disease (B = 3.86; 95% CI: 1.78-5.94), family history of atopic disease (B = 3.80; 95% CI: 1.84-5.77), older age of the child (B = 1.14; 95% CI: 0.20-2.07) and older age of the parent (B = 0.28; 95% CI: 0.04-0.53). Similarly, parents had poorer QoL if their infants had more severe AD (B = 2.56; 95% CI: 2.14-2.87), another atopic disease (B = 2.91; 95% CI: 0.99-4.84) or family history of atopic disease (B = 4.33; 95% CI: 2.57-6.09). CONCLUSIONS: Our results demonstrate that AD has a significant negative impact on infants' QoL as well as on QoL of their parents.

Does age influence the quality of life in children with atopic dermatitis?

BACKGROUND: Atopic dermatitis (AD) is one of the most common childhood skin diseases that can affect the quality of life (QoL) of children. The QoL of Montenegrin children with AD has not been sufficiently explored. The aim of this study was to assess their QoL with special emphasize on age differences. METHODS: This cross-sectional study included children with AD seen at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro (CCM) in Podgorica between August 2017 and July 2018. The QoL was assessed with the Infants' Dermatitis Quality of Life Index (IDQOL) and the Children's Dermatology Life Quality Index (CDLQI). Disease severity was measured by the Three Item Severity (TIS) score. RESULTS: A total of 386 children with AD aged from newborn to 16 years took part in this study. The mean total score of the QoL was 14.7 in infants (0-4 years old), 19.4 in younger children (5-9 years old), and 16.6 in older children (10-16 years old). Age was in negative correlation with the CDLQI score, leisure domain of the CDLQI and CDLQI sleep, and in positive correlation with the IDQOL child mood. TIS score was in positive correlation with both the IDQOL and CDLQI score. CONCLUSIONS: The QoL measured by CDLQI was more impaired in younger children, whilst IDQOL child mood was more impaired in older infants. The most impaired QoL was seen in children in the age group 5-9 years. Regardless of disease severity, treatment and counseling of children suffering from AD should be tailored specifically to their age.

Evaluation of the Impact of Black Carbon on the Worsening of Allergic Respiratory Diseases in the Region of Western Serbia: A Time-Stratified Case-Crossover Study.

Background and Objectives: Many epidemiological studies have shown a positive association between black carbon (BC) and the exacerbation of allergic rhinitis and allergic asthma. However, none of the studies in Serbia examined this relationship yet. The aim of this study was to examine the associations between BC and emergency department (ED) visits for allergic rhinitis and allergic asthma in the Uzice region of Serbia. Materials and Methods: A time-stratified case-crossover design was applied to 523 ED visits for allergic rhinitis and asthma exacerbation that occurred in the Uzice region of Serbia between 2012-2014. Data regarding ED visits were routinely collected in the Health Center of Uzice. The daily average concentrations of BC were measured by automatic ambient air quality monitoring stations. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity, and air pressure). Results: Statistically significant associations were observed between ED visits for allergic rhinitis and 2-day lagged exposure to BC (OR = 3.20; CI = 1.00-10.18; p = 0.049) and allergic asthma and 3-day lagged exposure to BC (OR = 3.23; CI = 1.05-9.95; p = 0.041). Conclusion: Exposure to BC in the Uzice region increases the risk of ED visits for allergic rhinitis and asthma, particularly during the heating season.