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

BACKGROUND: Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM: To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS: The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS: In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION: The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Demographic, clinical and microbiological characteristics of the first 30 human monkeypox confirmed cases attended in a tertiary hospital in Madrid (Spain), during the May-June 2022 international outbreak.

The present outbreak of Human Monkeypox (HMPX) that has begun in May 2022 and has spread across all continents in less than two months has qualitative and quantitative characteristics that make it different from the pattern of human disease previously caused by this virus. It has spread with enormous ease, affects almost exclusively adults, behaves as a sexually transmitted disease and focuses on very specific groups and transmission conditions. The high incidence in the city of Madrid in males that have sex with males (MSM) has allowed us to observe and report the experience with the first 30 cases diagnosed in our institution. Patients presented with febrile symptoms, genital and paragenital skin lesions reminiscent of smallpox, but less extensive and severe. The disease may also cause proctitis, pharyngitis and perioral lesions. The PCR test for diagnostic confirmation has been shown to be very sensitive and effective, not only in skin lesions but also in blood and other fluids such as pharyngeal, rectal exudates and blood. A very high proportion of patients with HMPX also have other sexually transmitted diseases that must be actively detected in this context. The spontaneous evolution of our patients has been good and hospitalization has been practically unnecessary. Transmission to non-sexual cohabitants and health personnel has been nonexistent and the lesions have disappeared in less than 30 days without leaving sequelae and no need for specific antiviral treatment.

The first 100 cases of COVID-19 in a Hospital in Madrid with a 2-month follow-up.

OBJECTIVE: There are few descriptions of the clinical presentation and evolution of consecutive SARS-CoV-2 infections with a long-enough follow up. METHODS: Description of the first consecutive 100 patients with microbiologically-proven COVID-19 in a large hospital in Madrid, Spain including a minimum of two-month follow up. RESULTS: The median age of the patients (52% males) was 61.5 years (IQR=39.5-82.0) and the median BMI was 28.8 kg/m2 (IQR=24.7-33.7). Overall 72% of the patients had one or more co-morbid conditions with a median age-adjusted Charlson index of 2 (IQR=0-5.7). Five patients (5%) were immunosuppressed. The most common symptoms at the time of diagnosis were fever (80.0%), cough (53.0%) and dyspnea (23.0%). The median O2 saturation at the time of first examination was 94% (IQR=90-97). Chest X-ray on admission was compatible with pneumonia in 63% of the cases (bilateral in 42% and unilateral in 21%). Overall, 30% were managed at home and 70% were admitted to the hospital. Thirteen patients were admitted to the ICU with a median of 11 days of stay in the Unit (IQR=6.0-28.0). CALL score of our population ranged from 4 to 13. Overall, 60.0% of patients received antibiotic treatment and 66.0%, empirical antiviral treatment, mainly with lopinavir/ritonavir (65%) or hydroxychloroquine (42%). Mortality, with a minimum of 60 days of follow up, was 23%. The median age of the deceased patients was 85 years (IQR=79-93). CONCLUSIONS: We found a high mortality in the first 100 patients diagnosed with COVID-19 at our institution, associated with advanced age and the presence of serious underlying diseases.

Clinical and economic evaluation of the impact of rapid microbiological diagnostic testing.

UNLABELLED: The clinical value of information provided by the Microbiology Laboratory may be reduced by the time it takes to generate results for healthcare providers. The aim of this study was to measure the clinical and economic impact associated with rapid reporting of microbiological results. METHODS: 574 hospitalized patients with a bacterial clinical infection confirmed by culture were evaluated. 284 hospitalized patients were included in the historical control group (results available the day following the analysis) and 290 in the intervention group (results available the same day of the analysis). The Vitek(®) 2 system (bioMérieux) was used for identification and antimicrobial susceptibility testing in both groups. RESULTS: Faster reporting of microbiological results enabled the clinician to optimize the antibiotic treatment sooner (P < 0.001). This reduction in turnaround time (17.6 h) was associated with improved clinical outcome, a significant reduction in the length of hospitalization and the number of microbiological and biochemical tests performed. Intubation requirements were significantly lower in the intervention group. Mortality rates did not differ significantly between the two groups. Costs incurred for patients in the intervention group were significantly lower than those in the control group, including costs for Microbiology Laboratory testing, antibiotic costs, length of hospitalization and other patient care costs. CONCLUSIONS: Rapid microbiological information was associated with quality improvement seen in earlier changes in antibiotic use, an improved clinical outcome and financial benefits.

Clinical and economic impact of rapid reporting of bacterial identification and antimicrobial susceptibility results of the most frequently processed specimen types.

Inappropriate antibiotic prescriptions are associated with an increase in healthcare costs and a decrease in the quality of care. The aim of this study was to measure the clinical and economic impact of rapid microbiological reporting on the specimens most frequently processed by the Microbiology Laboratory. The Vitek® 2 system (bioMérieux) was used for identification and susceptibility testing. Only hospitalized patients with bacterial infections were included. Two groups were established, a historical control group (results available the day following the analysis) and an intervention group (results available the same day of the analysis). Specimens studied and the median length of time from the introduction of the microorganism in the Vitek® 2 until microbiological report were as follows: wound and abscess (control = 23.5 h, intervention = 9.5 h, p < 0.001), blood (control = 23.5 h, intervention = 9.2 h, p < 0.001), and urine (control = 23.4 h, intervention = 9.3 h, p < 0.001). Outcome parameters were hospital stay and mortality rates. Hospital costs were calculated. The mortality rates did not differ significantly between the two groups. Faster reporting of identification and antimicrobial susceptibility results was associated with a significant reduction in hospital stay and in overall costs for those patients from whom wound, abscess, and urine specimens were analyzed. However, the antimicrobial results of blood culture isolates did not lead to significant clinical or financial benefits.

Expansion of CD8+CD57+ T Cells in an Immunocompetent Patient with Acute Toxoplasmosis.

CD57+ T cells increase in several viral infections like cytomegalovirus, herpesvirus, parvovirus, HIV and hepatitis C virus and are associated with several clinical conditions related to immune dysfunction and ageing. We report for the first time an expansion of CD8+ CD57+ T cells in a young patient with an acute infection with Toxoplasma gondii. Our report supports the concept that CD8+ CD57+ T cells could be important in the control of chronic phase of intracellular microorganisms and that the high numbers of these cells may reflect the continuing survey of the immune system, searching for parasite proliferation in the tissues.

[The value of the ultrasonography and computed tomography in diagnosis and monitoring of treatment of renal abscesses in children]. / Wartosc ultrasonografii i tomografii komputerowej w rozpoznawaniu i monitorowaniu leczenia ropni nerek u dzieci.

A retrospective study of 14 patients from 2 to 13 years old with renal abscess was performed. We evaluated the diagnostic value of ultrasonography (US) and computed tomography (CT) in diagnostic investigation and treatment of renal abscess, which have changed during the past ten years from classic surgical treatment to percutaneous drainage. US and CT have revealed the diagnosis by showing a hypoechogenic or hypodense mass in all 14 patients. All had an intensive course of antibiotic treatment. In 10 of them the abscess were drained percutaneously by US guided drainage. Percutaneous drainage was unsuccessful in 2 patients, who subsequently underwent classic surgical exploration, incision and drainage for uncontrolled infection. We conclude that US and CT greatly facilitate the diagnosis and permit the percutaneous drainage of renal abscess in paediatric age group, which benefits from this minimally invasive therapy.

Purtscher-like retinopathy in nephrotic syndrome associated with mild chronic renal failure.

A sudden loss of vision attributable to Purtscher-like retinopathy occurred in a 4-year-old boy with focal segmental glomerulosclerosis and nephrotic syndrome as well as mild chronic renal failure. This retinopathy was bilateral. After treatment with intravenous methylprednisolone, infusion of 20% albumin, and low molecular weight heparin (nadroparin calcium), his visual acuity improved within 3 days. Ischemic retinal blanching and hemorrhages gradually disappeared. The pathogenesis of this disorder is unknown.

[Prevalence of chlamydia trachomatis in the epithelial cells of the urethra in children]. / Wystepowanie Chlamydia trachomatis w komórkach nablonka cewki moczowej u dzieci.

Tests for the presence of Chlamydia trachomatis were performed in 432 children, aged 4 months to 16 years at the Department of Paediatric Nephrology of the Academy of Wroclaw, Poland. The children were hospitalised because of recurrent urinary tract infection. The presence of Chlamydia trachomatis was established in 27.5% of children by tissue culture on McCoy cells, in 22.8% when using the Chlamyset test (Orion Diagnostica) and in 8.9% when using the Chlamydiazyme test (Abbott).

[The evaluation of the applicability of urine samples for the detection of chlamydia trachomatis antigen in children]. / Ocena przydatnosci badania próbek moczu do wykrywania antygenów Chlamydia trachomatis u dzieci.

In 12 out of 66 children (18.2%), hospitalised at the Department of Pediatric Nephrology of the Medical Academy of Wroclaw, Poland, the presence of Chlamydia trachomatis was detected in the urinary sediment. The tests were made using an enzyme-linked-immunoassay, ELISA. These results are in 96.9% agreement with the results obtained by urethra swabs.

[Urinary tract infection caused by Chlamydia trachomatis in children]. / Zakazenia ukladu moczowego u dzieci wywolane przez Chlamydia trachomatis.

In 1988-1989, 131 children aged between 1 and 18 years were examined for urinary infections with C. trachomatis at the Department of Pediatric Urology in Wroclaw. Chlamydia trachomatis was diagnosed with the aid of McCoy's cellular cultures and immunoenzymatic test Chlamydiazyme in 25% of the examined children. A relationship between Chlamydia trachomatis and particular components of the clinical picture has been analysed. Effectiveness of the treatment with erythromycin (Davercin) and doxycycline (Vibramycin) has been also assessed.

Impaired bactericidal activity of serum of a child suffering from focal proliferative glomerulonephritis.

The serum of a child with focal proliferative glomerulonephritis was found to exhibit a weaker bactericidal activity against Pseudomonas aeruginosa, Salmonella typhimurium, Salmonella enteritidis and Escherichia coli strains as compared with sera of the child's parents. The child's serum showed a low haemolytical activity of complement as well as a low C3 concentration. The authors believe that the abnormal complement concentration could cause the impaired bactericidal activity of the patient serum.