Determining utility values related to malaria and malaria chemoprophylaxis

<p>Abstract</p> <p>Background</p> <p>Chemoprophylaxis for travellers' malaria is problematic. Decision modeling may help determine optimal prevention strategies for travellers' malaria. Such models can fully assess effect of drug use and disease on quality of life, and help travellers make informed values based decisions. Such models require utility values reflecting societal preferences over different health states of relevance. To date, there are no published utility values relating to clinical malaria or chemoprophylaxis adverse events.</p> <p>Methods</p> <p>Utility estimates for health states related to falciparum malaria, sequelae and drug-related adverse events were obtained using a self-administered visual analogue scale in 20 individuals. Utility values for health states related to clinical malaria were obtained from a survey of 11 malaria experts questioned about length of hospital stay or equivalent disability with simple and severe travellers' malaria.</p> <p>Results</p> <p>The general public (potential travellers), were more tolerant of taking prophylaxis if associated with no or mild AEs and least tolerant of mild sequelae from malaria and severe drug related events. The rating value reported for taking no prophylaxis was quite variable. Tropical medicine specialists estimated a mean hospital stay 3.23 days (range 0.5-4.5 days) for simple and 6.36 days (range 4.5 - 7 days) for severe malaria.</p> <p>Conclusions</p> <p>This study provides a benchmark for important utility value estimates for modeling malaria and drug-related outcomes in non-immune travellers.</p

Additional risk factors for infection by multidrug-resistant pathogens in healthcare-associated infection: a large cohort study

<p>Abstract</p> <p>Background</p> <p>There is a lack of consensus regarding the definition of risk factors for healthcare-associated infection (HCAI). The purpose of this study was to identify additional risk factors for HCAI, which are not included in the current definition of HCAI, associated with infection by multidrug-resistant (MDR) pathogens, in all hospitalized infected patients from the community.</p> <p>Methods</p> <p>This 1-year prospective cohort study included all patients with infection admitted to a large, tertiary care, university hospital. Risk factors not included in the HCAI definition, and independently associated with MDR pathogen infection, namely MDR Gram-negative (MDR-GN) and ESKAPE microorganisms (vancomycin-resistant <it>Enterococcus faecium</it>, methicillin-resistant <it>Staphylococcus aureus</it>, extended-spectrum beta-lactamase-producing <it>Escherichia coli</it> and <it>Klebsiella</it> species, carbapenem-hydrolyzing <it>Klebsiella pneumonia</it> and MDR <it>Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter</it> species), were identified by logistic regression among patients admitted from the community (either with community-acquired or HCAI).</p> <p>Results</p> <p>There were 1035 patients with infection, 718 from the community. Of these, 439 (61%) had microbiologic documentation; 123 were MDR (28%). Among MDR: 104 (85%) had MDR-GN and 41 (33%) had an ESKAPE infection. Independent risk factors associated with MDR and MDR-GN infection were: age (adjusted odds ratio (OR) = 1.7 and 1.5, <it>p</it> = 0.001 and <it>p</it> = 0.009, respectively), and hospitalization in the previous year (between 4 and 12 months previously) (adjusted OR = 2.0 and 1,7, <it>p</it> = 0.008 and <it>p</it> = 0.048, respectively). Infection by pathogens from the ESKAPE group was independently associated with previous antibiotic therapy (adjusted OR = 7.2, <it>p</it> < 0.001) and a Karnofsky index <70 (adjusted OR = 3.7, <it>p</it> = 0.003). Patients with infection by MDR, MDR-GN and pathogens from the ESKAPE group had significantly higher rates of inadequate antibiotic therapy than those without (46% <it>vs</it> 7%<it>,</it> 44% <it>vs</it> 10%<it>,</it> 61% vs 15%, respectively, <it>p</it> < 0.001).</p> <p>Conclusions</p> <p>This study suggests that the inclusion of additional risk factors in the current definition of HCAI for MDR pathogen infection, namely age >60 years, Karnofsky index <70, hospitalization in the previous year, and previous antibiotic therapy, may be clinically beneficial for early diagnosis, which may decrease the rate of inadequate antibiotic therapy among these patients.</p