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1.
Am Surg ; 88(6): 1381-1382, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35331015

ABSTRACT

We read with interest the retrospective chart review "Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admission for Snakebites" by Bowden, et al. The efficacy of US snake antivenoms has been well established for decades. A randomized double-blind placebo-controlled clinical trial (RCT) has demonstrated Fab antivenom efficacy using patient-centered outcomes such as return of functionality and other patient-reported outcomes. These benefits occurred in a predominantly mildly envenomated patient population in a time-dependent manner. The cost-effectiveness of snake antivenom has been demonstrated globally, but no US cost-effectiveness studies have been published. Based on the evidence hierarchy of evidence-based medicine, the discordance between this study and the RCT merits discussion.


Subject(s)
Antivenins , Snake Bites , Antivenins/therapeutic use , Cost-Benefit Analysis , Hospitalization , Humans , Retrospective Studies , Snake Bites/complications , Snake Bites/therapy
2.
Infect Control Hosp Epidemiol ; 43(4): 442-447, 2022 04.
Article in English | MEDLINE | ID: mdl-34284846

ABSTRACT

OBJECTIVE: To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport. METHODS: We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome. RESULTS: In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09-12.71; P = .04). CONCLUSIONS: Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport-associated infection burden to eventually develop interventions to address it.


Subject(s)
Gram-Positive Bacterial Infections , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Vancomycin-Resistant Enterococci , Ambulances , Cohort Studies , Gram-Positive Bacterial Infections/epidemiology , Humans , Propensity Score , Retrospective Studies , Staphylococcal Infections/epidemiology , Vancomycin , Vancomycin Resistance
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