Economic burden of inpatient and outpatient antibiotic treatment for methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections

Previous economic analyses evaluating treatment of methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infections (cSSTI) failed to include all direct treatment costs such as outpatient parenteral antibiotic therapy (OPAT). Our objective was to develop an economic model from a US payer perspective that includes all direct inpatient and outpatient costs incurred by patients with MRSA cSSTI receiving linezolid, vancomycin, or daptomycin. A 4-week decision model was developed for this economic analysis. Published literature and database analyses with validation by experts provided clinical, resource use, and cost inputs on data such as efficacy rate, length of stay, adverse events, and OPAT services. Base-case analysis assumed equal efficacy and equal length of stay for treatments. We conducted several sensitivity analyses where assumptions on resource use or efficacy were varied. Costs were reported in year-end 2011 US dollars. Total treatment costs in the base-case were lower for linezolid ($10,571) than vancomycin ($11,096), and daptomycin ($13,612). Inpatient treatment costs were$740 more, but outpatient costs, $1,266 less with linezolid than vancomycin therapy due to a switch to oral linezolid when the patient was discharged. Compared with daptomycin, both inpatient and outpatient treatment costs were lower with linezolid by$87 and $2,954 respectively. In sensitivity analyses, linezolid had lower costs compared with vancomycin and daptomycin when using differential length of stay data from a clinical trial, and using success rates from a meta-analysis. In a scenario without peripherally inserted central catheter line costs, linezolid became slightly more expensive than vancomycin (by$285), but remained less costly than daptomycin (by $2,316). Outpatient costs of managing MRSA cSSTI may be reduced by 30%–50% with oral linezolid compared with vancomycin or daptomycin. Results from this analysis support potential economic benefit and cost savings of using linezolid versus traditional OPAT when total inpatient and outpatient medical costs are evaluated

Central Nervous System Complications in Civilians’ Blast – Induced Head Injuries

Objective: To evaluate the frequency of central nervous system complications in civilians with explosive related head injuries.Material and Methods: This observational study was conducted at Neurosurgery Department, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar – Pakistan, from January 2009 to December 2011 (3 years). We included all the patients with explosive related head injuries who were hospitalized, of all age groups and both genders, and excluded those patients who died before hospitalization. We also excluded patients with head injuries having neurovascular complications or had neurological deficit.Results: We had total of 191 patients with bomb blast head injuries treated in Lady Reading Hospital. One sixty six (86.9%) patients were male and 25 (13.1%) female with male / female ratio of 6.6:1. Their age ranged from 2 months of 71 years. Almost 65% of the patients were in their 2nd, 3rd and 4th decades of life. The common CNS complications in our patients were infections (12.04%), cerebrospinal fluid (CSF) leak (8.38%), epilepsy (5.2%) and post-traumatic hydrocephalous (3.7%). Mortality rate was 11%.Conclusion: We conclude from this study that central nervous system infections are the common (12.04%) complication of civilian explosive related head injuries followed by cerebrospinal fluid leak, seizures and hydro-cephalous respectively. Over all morbidity is 29.32% and mortality rate is 11% in those head injured patients who reach to hospital

Antibiotic treatment patterns across Europe in patients with complicated skin and soft-tissue infections due to meticillin-resistant <em>Staphylococcus aureus</em>:a plea for implementation of early switch and early discharge criteria

AbstractThis retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ≥18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area

Influence of real-world characteristics on outcomes for patients with methicillin-resistant Staphylococcal skin and soft tissue infections:a multi-country medical chart review in Europe

BACKGROUND: Patient-related (demographic/disease) and treatment-related (drug/clinician/hospital) characteristics were evaluated as potential predictors of healthcare resource use and opportunities for early switch (ES) from intravenous (IV)-to-oral methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotic therapy and early hospital discharge (ED). METHODS: This retrospective observational medical chart study analyzed patients (across 12 European countries) with microbiologically confirmed MRSA complicated skin and soft tissue infections (cSSTI), ≥3 days of IV anti-MRSA antibiotics during hospitalization (July 1, 2010-June 30, 2011), and discharged alive by July 31, 2011. Logistic/linear regression models evaluated characteristics potentially associated with actual resource use (length of IV therapy, length of hospital stay [LOS], IV-to-oral antibiotic switch), and ES and ED (using literature-based and expert-verified criteria) outcomes. RESULTS: 1542 patients (mean ± SD age 60.8 ± 16.5 years; 61.5% males) were assessed with 81.0% hospitalized for MRSA cSSTI as the primary reason. Several patient demographic, infection, complication, treatment, and hospital characteristics were predictive of length of IV therapy, LOS, IV-to-oral antibiotic switch, or ES and ED opportunities. Outcomes and ES and ED opportunities varied across countries. Length of IV therapy and LOS (r = 0.66, p < 0.0001) and eligibilities for ES and ED (r = 0.44, p < 0.0001) showed relatively strong correlations. IV-to-oral antibiotic switch patients had significantly shorter length of IV therapy (−5.19 days, p < 0.001) and non-significantly shorter LOS (−1.86 days, p > 0.05). Certain patient and treatment characteristics were associated with increased odds of ES (healthcare-associated/ hospital-acquired infection) and ED (patient living arrangements, healthcare-associated/ hospital-acquired infection, initiating MRSA-active treatment 1–2 days post cSSTI index date, existing ED protocol), while other factors decreased the odds of ES (no documented MRSA culture, ≥4 days from admission to cSSTI index date, IV-to-oral switch, IV line infection) and ED (dementia, no documented MRSA culture, initiating MRSA-active treatment ≥3 days post cSSTI index date, existing ES protocol). CONCLUSIONS: Practice patterns and opportunity for further ES and ED were affected by several infection, treatment, hospital, and geographical characteristics, which should be considered in identifying ES and ED opportunities and designing interventions for MRSA cSSTI to reduce IV days and LOS while maintaining the quality of care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2334-14-476) contains supplementary material, which is available to authorized users

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A number of xenobiotic-inducible cytochrome P450s (CYPs) are now known to be localized in the mitochondrial compartment, though their pharmacological or toxicological roles remain unclear. Here, we show that BNF treatment markedly inhibits liver mitochondrial O2 consumption rate (OCR), ADP-dependent OCR, and also reserve OCR, in wild-type mice but not in Cyp1a1/1a2(−/−) double knockout mice. BNF treatment markedly affected mitochondrial complex I and complex IV activities and also attenuated mitochondrial gene expression. Furthermore, under in vitro conditions, BNF treatment induced cellular ROS production, which was inhibited by mitochondria-targeted antioxidant Mito-CP and CYP inhibitor proadefin, suggesting that most of the ROS production was intramitochondrial and probably involved the catalytic activity of mitochondrial CYP1 enzymes. Interestingly, our results also show that the AHR antagonist resveratrol, markedly attenuated BNF-induced liver mitochondrial defects in wild-type mice, confirming the role of AHR and AHR-regulated CYP1 genes in eliciting mitochondrial dysfunction. These results are consistent with reduced BNF-induced mitochondrial toxicity in Cyp1a1/1a2(−/−) mice and elevated ROS production in COS cells stably expressing CYP1A1. We propose that increased mitochondrial ROS production and respiratory dysfunction are part of xenobiotic toxicity. Resveratrol, a chemopreventive agent, renders protection against BNF-induced toxicity

Characteristics and experiences of peer counsellors in urban Dhaka: a structured interview study

Interventions to promote breastfeeding are the cornerstone of efforts to reduce childhood illness and death from undernutrition. Evidence suggests that one of the most effective strategies to increase breastfeeding is through peer counsellors. However, the experiences of peer counsellors has not been studied in depth. This study aimed to collect and report the experiences of peer counsellors participating in an intervention study to improve breastfeeding in urban Dhaka, Bangladesh.Peer counsellors underwent a 10 day training course in May 2013 which included practical sessions on position and attachment and common difficulties with breastfeeding. Home visits were conducted with new mothers and performance of peer counsellors was monitored by senior breastfeeding counsellors. The number of supervised home visits needed to achieve a satisfactory level of competency was recorded. Demographic data were collected and a structured interview was performed in the first six months of the project (May-September 2013). One structured interview per peer counsellor was conducted by the project manager at the project site office to gain understanding of their experiences in counselling mothers. The interview included some open-ended questions on specific aspects of the training that they found useful, challenges faced, and whether they developed close friendships with the mothers that they were counselling.Seventeen peer counsellors with an average age of 31 years (SD 6.8) and at least six years of schooling participated in the study. All peer counsellors were satisfied with their role and with the training that they received, and most felt that they were able to deal with common breastfeeding problems. The peer counsellors reported that building a personal rapport and establishing a peer-to-peer relationship was most important in supporting mothers to breastfeed. Common challenges included interruption of sessions by relatives/children, as well as mothers being too busy for the visits.In future peer counselling for breastfeeding projects, more focus could be placed on the communications aspects of the training, especially in how to deal with non-supportive family members and managing interruptions effectively, as well as how to motivate and engage busy new mothers

Out-of-Pocket Costs and Prescription Reversals: the case of Oral Linezolid

Kim A. Caldwell, RPh Employed by Humana Inc., Kim is the Director of Pharmacy Professional Affairs for Humana Pharmacy Solutions. In this role, he and his team serve to liaison between HPS business owners, Humana Public Affairs, and key professional and trade partners. They serve as the pharmacy subject matter experts aligned with key business and regulatory issues, including visits with members of federal and state legislatures as well as the interface with state boards of pharmacy and key trade organizations. Previously, he started and directed Competitive Health Analytics, Inc. (CHA) a business unit within Humana Inc. for the first four years of operations. As an evidence-based research group focusing on key healthcare questions in collaboration with private, public, and internal research partners, using the comprehensive Humana database, CHA engaged in extensive work relating to comparative effectiveness research, post-marketing surveillance, return-on-investment queries, and numerous scenario-based healthcare studies

Molecular and epidemiological characterisation of clinical isolates of carbapenem-resistant Acinetobacter baumannii from public and private sector intensive care units in Karachi, Pakistan

The Purpose of this study was to identify molecular and epidemiological characteristics of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) from two different intensive care unit (ICU) settings in Karachi, Pakistan. A cross-sectional study was performed in the adult ICUs of a private sector tertiary care hospital (PS-ICU) and of a government sector hospital (GS-ICU) between November 2007 and August 2008. Deduplicated CRAB isolates from clinical specimens were examined for carbapenemase and class 1 integrase genes. Isolates were typed using sequence-based multiplex polymerase chain reaction, pulsed-field gel electrophoresis (PFGE) and variable number tandem repeat (VNTR). A total of 50 Patients (33 from PS-ICU and 17 from GS-ICU) were recruited. There were statistically significant differences between Patients in the two ICUs in terms of mean age, comorbidities, the presence of central venous pressure lines, urinary catheters, and average length of stay. bla(OxA-23-like) acquired-oxacillinase genes were found in 47/50 isolates. Class 1 integrase genes were found in 50% (25/50) of the organisms. The majority of isolates belonged to strains of European clones I and II. PFGE typing grouped the isolates into eight distinct clusters, three of which were found in both hospitals. Most of the isolates within each PFGE cluster shared identical or highly similar VNTR profiles, suggesting close epidemiological association. Irrespective of differences in risk factors and infection control policies and practices, the extent of clonality among CRAB isolates was very similar in both ICU settings