Direct medical costs of COPD diagnosis and treatment, Eastern vs. Western European country : examples of Serbia and Belgium

OBJECTIVE: Comparison of COPD financial burden and underlying factors, between Eastern upper middle income and a Western European high income, healthcare settings. METHODS: The patient sample was 433 in Belgium and 322 in Serbia, age ≥ 40, with spirometry and clinically confirmed COPD diagnosis. Belgian trial followed patients prospectively during 2006, using structured survey of clinicians in charge. Serbian trial conducted in 2008, retrieved data from clinical invoice database. Time horizon was one year and perspective of third party payers was taken into account for both studies. Clinical outcomes of interest were disease exacerbation, hospital admission and death. Economic inputs referred to COPD-attributable medical services consumption value during observed period of time. RESULTS: Average annual cost was 1,812.84 € for the Serbian patients and 1,738.13 €/year for the Belgian patients (not including the value of laboratory diagnostics or imaging techniques). Severity grade and duration of hospital admissions significantly directly correlated with overall cost in both populations. Pattern of diagnostic procedures requested and ATC classes of drug consumed to treat COPD remains similar and comparable in both countries. GDP per capita ratio in respective years (10.4: 37.4), exhibits the paradox of patient being much less affordable to treat in a less developed society. CONCLUSIONS: Burden of COPD in Europe is huge and, due to contemporary life style expected to grow further. We compared cost of illness structures between two societies with different macroeconomic past in healthcare financing and management. According to our findings, direct medical costs were driven by exacerbations and hospital admissions. Significantly cheaper human labor caused higher relative relevance of drug acquisition expenses in the East and higher portion of hospital admission costs in the West. More in-depth research of indirect COPD attributable costs (e.g. lost productivity, absenteeism, premature death etc) will be needed in future. It implies serious health policy necessities to provide accessibility of care

The effects of detergent, sodium tripoly-phosphate and ethoxyled oleyl-cetyl alcohol on metabolic parameters of the fungus trichothecium roseum link

The degradation of detergents that are dispersed in water and soil partially depends on the metabolic activities of fungi. Among the fungi that have this ability, Deuteromycetes are particularly noted for their biochemical characteristics. Taking this into account, it was of interest to analyze the influence of detergent and its main compounds, ethoxyled oleylcetyl alcohol (AOC) and sodium tripoly-phosphate (TTP), on the metabolism of the fungus Trichothecium roseum. Our results revealed that both detergent and AOC had an inhibitory effect on the bioproduction of free organic acids, while TTP stimulated their production. Also, detergent inhibited the bioproduction of basic amino acids, with the exception of alanine. In addition, detergent applied at 1% concentration inhibited the bioproduction of proteins and the total biomass of the fungus, while AOC and TTP inhibited the production of proteins, but stimulatedl the production of Trichothecium

Risk factors for hospital infections caused by carbapanem-resistant Acinetobacter baumannii

© 2016 Djordjevicet al. Introduction: Acinetobacter baumannii is one of major causative agents of severe, life-threatening hospital infections (HIs), especially in intensive care units (ICUs). Our aim was to discover the risk factors associated with the emergence of HIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB), as well as those associated with death in patients who suffer from such infections. Methodology: A prospective cohort study was conducted over a five-year period in the medical-surgical ICU of the Clinical Centre in Kragujevac, Serbia. The study group comprised patients who had HIs caused by CRAB, while the control group comprised patients infected with carbapenem-sensitive Acinetobacter baumannii. Results: In total, 137 patients developed HIs caused by Acinetobacter baumannii. The mean age of the patients was 59.65 ± 16.08 years, and 99 (72.26%) of them were males. In 95 patients (69.35%), the infection was caused by CRAB. There were six independent risk factors for CRAB infections: use of mechanical ventilation, previous stay in another department, stay in ICU for more than a month, and previous use of carbapenems, aminoglycosides, and metronidazole. Three independent risk factors were found for death in patients with HIs caused by CRAB: use of mechanical ventilation, previous stay in another department, and previous use of carbapenems. Conclusions: The results of this study can be helpful when identifying patients with risk of HIs caused by CRAB and in planning preventive measures. Modification of known risk factors and appropriate institutional policy of antibiotic utilization are important measures that may decrease the incidence and mortality of such infections

Risk factors of nosocomial infections caused by piperacillin-tazobactam resistant Pseudomonas aeruginosa

Introduction Pseudomonas aeruginosa is a common cause of serious infections in hospitalized patients and is associated with high rates of hospital morbidity and mortality. Objective The aim of this study was to identify the risk factors of nosocomial infections caused by piperacillin-tazobactam-resistant P. aeruginosa (PT-RPA). Methods A case-control study was conducted in the Clinical Centre Kragujevac from January 2010 to December 2011. Results In the observed period, 79 (38.16%) patients had PTRPA infections, while 128 (61.84%) patients had infections caused by piperacillin-tazobactam-sensitive P. aeruginosa (PT-SPA). Pneumonia was more frequently found in the PT-RPA group (55.70%) (p<0.05), whereas urinary tract infections were more frequent in the group of patients with PT-SPA infections (26.56%) (p<0.01). Multivariate analysis was used to identify an injury on admission (OR=3.089; 95%CI=1.438-6.635; p=0.004), administration of imipenem (OR=15.027; 95%CI=1.778-127.021; p=0.013), meropenem (OR=2.618; 95%CI=1.030-6.653; p=0.043), ciprofloxacin (OR=3.380; 95%CI=1.412-8.090; p=0.006), vancomycin (OR=4.294; 95%CI=1.477-12.479; p=0.007), piperacillin-tazobactam (OR=4.047; 95%CI=1.395-11.742; p=0. 010) as independent risk factors associated with PT-RPA infection. Conclusion In hospitalized patients, the risk of PT-RPA infec tions is associated with previous administration of imipenem, meropenem, ciprofloxacin, vancomycin, piperacillin-tazobac tam, and the presence of injury on admission

Analysis of the amino acids of some types of fungi cultivated in the presence of detergent

The paper presents the results of the influence of anionic-type detergent containing sodium tripolyphosphate and ethoxylated oleylcetyl alcohol on the type and quantity of present amino acids in the fermentation broths of the fungi Aspergillus niger, Alternaria tenuis and Fusarium oxysporum cultivated on a medium with the addition of 1% detergent as a function of their application in the process of detergent biodegradation. In the case of A.niger the stimulation of the biosynthesis of 15 various amino acids was determined. In the case of A.tenuis the production of 14 amino acids was inhibited as compared to the total number of 15 amino acids identified when the fungi were cultivated in the absence of detergent, whereby the explicit inhibition of the synthesis of methionine, isoleucine and leucine was registered. Detergent (1% concentration) exhibits a stimulating effect on the bioproduction of amino acids in the case of the fungus F.oxysporum when the presence of 14 amino acids was identified

Hospital infections in a neurological intensive care unit: Incidence, causative agents and risk factors

Introduction: Hospital infections (HIs), which are frequently associated with hospital treatment, increase morbidity, mortality and treatment costs. The aim of this study was to establish the incidence of HIs in a neurological intensive care unit (nICU), and to determine the most prevalent causative agents and risk factors for HIs. Methodology: A cross-sectional study with nested case-control design was conducted between 1 July 2009 and 30 June 2010 at an 18-bed neurological intensive care unit at the Clinical Center Kragujevac, Serbia. Results: In total, 537 patients were enrolled in the study, with 6,549 patient-days. There were 89 patients with 101 HIs. The incidence of patients with HIs was 16.57%, and incidence of HIs was 18.81%, while density of HIs was 15.42 per 1,000 patient-days. The most frequent anatomical sites of HIs were urinary tract (73.27%), blood (10.89%), and skin and soft tissues (10.89%). The following risk factors were identified: co-morbidity (OR=3.9; 95% CI=1.9-7.9), surgical intervention in the last 30 days (OR=5.6; 95% CI=1.5-20.4), urinary bladder catheterization longer than seven days (OR=3.8; 95% CI=1.8-8.2), value of Glasgow coma scale ≤ 9 (OR=3.7; 95% CI=1-6.9), and longer hospital stay (OR=1.1; 95% CI=1.1-1.2). Conclusions: Hospitalization in an nICU bears high risk of HIs, especially of urinary tract infections caused by Gram-negative bacteria, in patients with longer hospital stay or co-morbidities, and in those who have had surgical interventions or prolonged use of a urinary bladder catheter. Special attention should be paid to these patients to prevent HIs. © 2012 Djordjevic et al