Cost of hospital management of Clostridium difficile infection in United States - a meta-analysis and modelling study

Background: Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain. Methods: We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation. Results: The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90$ 39,886, $44,765) and$ 21,448 (90 % CI: $21,152,$ 21,744) in 2015 US dollars. Hospital-onset CDIattributable cost per case was $34,157 (90$ 33,134, $35,180), which was 1.5 times the cost of communityonset CDI ($ 20,095 [ 90 % CI: $4991,$ 35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range:$ 1.9-$ 7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay. Conclusions: This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.Sanofi PasteurSCI(E)[email protected]

Fundamentals and Applications of Chitosan

International audienceChitosan is a biopolymer obtained from chitin, one of the most abundant and renewable material on Earth. Chitin is a primary component of cell walls in fungi, the exoskeletons of arthropods, such as crustaceans, e.g. crabs, lobsters and shrimps, and insects, the radulae of molluscs, cephalopod beaks, and the scales of fish and lissamphibians. The discovery of chitin in 1811 is attributed to Henri Braconnot while the history of chitosan dates back to 1859 with the work of Charles Rouget. The name of chitosan was, however, introduced in 1894 by Felix Hoppe-Seyler. Because of its particular macromolecular structure, biocompatibility, biode-gradability and other intrinsic functional properties, chitosan has attracted major scientific and industrial interests from the late 1970s. Chitosan and its derivatives have practical applications in food industry, agriculture, pharmacy, medicine, cos-metology, textile and paper industries, and chemistry. In the last two decades, chito-san has also received much attention in numerous other fields such as dentistry, ophthalmology, biomedicine and bio-imaging, hygiene and personal care, veterinary medicine, packaging industry, agrochemistry, aquaculture, functional textiles and cosmetotextiles, catalysis, chromatography, beverage industry, photography, wastewater treatment and sludge dewatering, and biotechnology. Nutraceuticals and cosmeceuticals are actually growing markets, and therapeutic and biomedical products should be the next markets in the development of chitosan. Chitosan is also the N. Morin-Crini (*) · Laboratoire Chrono-environnement, UMR 6249, UFR Sciences et Techniques