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1.
J Hosp Infect ; 103(2): 134-141, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31228511

ABSTRACT

BACKGROUND: Multi-drug resistant (MDR) Pseudomonas aeruginosa can negatively affect patients and hospitals. AIM: To evaluate excess mortality and cost burden among patients hospitalized with suspected respiratory infections due to MDR P. aeruginosa vs patients with non-MDR P. aeruginosa in 78 United States (US) hospitals. METHODS: This study analyzed electronically captured microbiological and outcomes data of patients hospitalized with non-duplicate P. aeruginosa isolates from respiratory sources collected ≥3 days after admission to identify hospital-onset MDR or non-MDR P. aeruginosa per the Centers for Disease Control and Prevention definition. The risk of multi-drug resistance was estimated on mortality, length of stay (LOS), cost, operation gain/loss, and 30-day readmission. A sensitivity analysis was conducted utilizing a cohort with pharmacy data available. FINDINGS: Of 523 MDR and 1381 non-MDR P. aeruginosa cases, unadjusted mortality was 23.7% vs 18.0% and multi-variable-adjusted mortality was 20.0% (95% confidence interval (CI): 14.3-27.2%) vs 15.5% (95% CI: 11.2-20.9%; P=0.026), the average adjusted excess LOS was 6.7 days (P<0.001); excess cost per case was US$22,370 higher (P=0.002) and operational loss per case was US$10,661 (P=0.024) greater, and the multi-variable adjusted readmission rate was 16.2% (95% CI: 11.2-22.9%) vs 11.1% (95% CI: 7.8-15.6%; P=0.006). The sensitivity analysis yielded similar results. CONCLUSIONS: Compared with suspected infections due to non-MDR P. aeruginosa, patients with MDR P. aeruginosa had higher risk of mortality, readmission, and longer LOS, as well as US$20,000 incremental cost and >US$10,000 incremental net loss per case after controlling for patient and hospital characteristics.


Subject(s)
Cost of Illness , Drug Resistance, Multiple, Bacterial , Pseudomonas Infections/economics , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/drug effects , Respiratory Tract Infections/economics , Respiratory Tract Infections/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Health Care Costs , Hospitals , Humans , Length of Stay , Male , Middle Aged , Pseudomonas Infections/microbiology , Pseudomonas Infections/mortality , Pseudomonas aeruginosa/isolation & purification , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/mortality , Survival Analysis , United States/epidemiology , Young Adult
2.
J Hosp Infect ; 102(1): 37-44, 2019 May.
Article in English | MEDLINE | ID: mdl-30503367

ABSTRACT

BACKGROUND: Gram-negative complicated urinary tract infections (cUTIs) can have serious consequences for patients and hospitals. AIM: To examine the clinical and economic burden attributable to Gram-negative carbapenem-non-susceptible (C-NS; resistant/intermediate) infections compared with carbapenem-susceptible (C-S) infections in 78 US hospitals. METHODS: All non-duplicate C-NS and C-S urine source isolates were analysed. A subset had principal diagnosis ICD-9-CM codes denoting cUTI. Collection time (<3 vs ≥3 days after admission) determined isolate classification as community or hospital onset. Mortality, 30-day re-admissions, length of stay (LOS), hospital cost and net gain/loss in US dollars were determined for C-NS and C-S cases, with the C-NS-attributable burden estimated through propensity score matching. Three subgroups with adequate patient numbers were analysed: cUTI principal diagnosis, community onset; other principal diagnosis, community onset; and other principal diagnosis, hospital onset. FINDINGS: The C-NS-attributable mortality risk was significantly higher (58%) for the other principal diagnosis, hospital-onset subgroup alone (odds ratio 1.58, 95% confidence interval 1.14-2.20; P < 0.01). The C-NS-attributable risk for 30-day re-admission ranged from 29% to 55% (all P < 0.05). The average attributable economic impact of C-NS was 1.1-3.9 additional days LOS (all P < 0.05), US$1512-10,403 additional total cost (all P < 0.001) and US$1582-11,848 net loss (all P < 0.01); overall burden and C-NS-attributable burden were greatest in the other principal diagnosis, hospital-onset subgroup. CONCLUSION: Greater clinical and economic burden was observed in propensity-score-matched patients with C-NS infections compared with C-S infections, regardless of whether cUTI was the principal diagnosis, and this burden was most severe in hospital-onset infections.


Subject(s)
Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Cost of Illness , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/epidemiology , Urinary Tract Infections/epidemiology , beta-Lactam Resistance , Adolescent , Adult , Aged , Aged, 80 and over , Female , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/mortality , Gram-Negative Bacterial Infections/pathology , Health Care Costs , Humans , Length of Stay , Male , Middle Aged , Prevalence , Survival Analysis , Urinary Tract Infections/microbiology , Urinary Tract Infections/mortality , Urinary Tract Infections/pathology , Young Adult
3.
Bone Joint Res ; 5(7): 280-6, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27388715

ABSTRACT

OBJECTIVES: The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. METHODS: The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated. RESULTS: The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively. CONCLUSION: This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarir, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280-286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1.

4.
Diabetologia ; 53(5): 914-23, 2010 May.
Article in English | MEDLINE | ID: mdl-20146051

ABSTRACT

AIMS/HYPOTHESIS: Skin and soft tissue infections (SSTIs) cause substantial morbidity in persons with diabetes. There are few data on pathogens or risk factors associated with important outcomes in diabetic patients hospitalised with SSTIs. METHODS: Using a clinical research database from CareFusion, we identified 3,030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007. We classified the culture isolates and analysed their association with the anatomic location of infection, mortality, length of stay and hospital costs. RESULTS: The only culture isolate with a significantly increased prevalence was methicillin-resistant Staphylococcus aureus (MRSA); prevalence for infection of the foot was increased from 11.6 to 21.9% (p < 0.0001) and for non-foot locations from 14.0% to 24.6% (p = 0.006). Patients with non-foot (vs foot) infections were more severely ill at presentation and had higher mortality rates (2.2% vs 1.0%, p < 0.05). Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa (OR 3.1), a monomicrobial culture with other gram-negatives (OR 8.9), greater illness severity (OR 1.9) and being transferred from another hospital (OR 5.1). These factors and need for major surgery were also independently associated with longer length of stay and higher costs. CONCLUSIONS/INTERPRETATION: Among diabetic patients hospitalised with SSTI from 2003 to 2007, only MRSA increased in prevalence. Patients with non-foot (vs foot) infections were more severely ill. Independent risk factors for increased mortality rates, length of stay and costs included more severe illness, transfer from another hospital and wound cultures with Pseudomonas or other gram-negatives.


Subject(s)
Diabetes Complications/epidemiology , Iatrogenic Disease/epidemiology , Length of Stay/economics , Pseudomonas Infections/epidemiology , Soft Tissue Infections/epidemiology , Staphylococcal Skin Infections/epidemiology , Diabetes Complications/economics , Diabetes Complications/microbiology , Diabetes Mellitus/economics , Diabetes Mellitus/microbiology , Health Care Costs , Humans , Iatrogenic Disease/economics , Inpatients , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Prevalence , Pseudomonas/isolation & purification , Pseudomonas Infections/economics , Pseudomonas Infections/etiology , Risk Factors , Soft Tissue Infections/economics , Soft Tissue Infections/etiology , Staphylococcal Skin Infections/economics , Staphylococcal Skin Infections/etiology
5.
Gut ; 57(12): 1698-703, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18519429

ABSTRACT

BACKGROUND: Identification of patients at risk for mortality early in the course of acute pancreatitis (AP) is an important step in improving outcome. METHODS: Using Classification and Regression Tree (CART) analysis, a clinical scoring system was developed for prediction of in-hospital mortality in AP. The scoring system was derived on data collected from 17,992 cases of AP from 212 hospitals in 2000-2001. The new scoring system was validated on data collected from 18,256 AP cases from 177 hospitals in 2004-2005. The accuracy of the scoring system for prediction of mortality was measured by the area under the receiver operating characteristic curve (AUC). The performance of the new scoring system was further validated by comparing its predictive accuracy with that of Acute Physiology and Chronic Health Examination (APACHE) II. RESULTS: CART analysis identified five variables for prediction of in-hospital mortality. One point is assigned for the presence of each of the following during the first 24 h: blood urea nitrogen (BUN) >25 mg/dl; impaired mental status; systemic inflammatory response syndrome (SIRS); age >60 years; or the presence of a pleural effusion (BISAP). Mortality ranged from >20% in the highest risk group to <1% in the lowest risk group. In the validation cohort, the BISAP AUC was 0.82 (95% CI 0.79 to 0.84) versus APACHE II AUC of 0.83 (95% CI 0.80 to 0.85). CONCLUSIONS: A new mortality-based prognostic scoring system for use in AP has been derived and validated. The BISAP is a simple and accurate method for the early identification of patients at increased risk for in-hospital mortality.


Subject(s)
Hospital Mortality , Multiple Organ Failure/mortality , Pancreatitis/mortality , Severity of Illness Index , APACHE , Adult , Aged , Aged, 80 and over , Area Under Curve , Female , Humans , Male , Middle Aged , Prognosis , United States/epidemiology , Young Adult
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