Daily antibiotic cost of nosocomial infections in a Turkish university hospital

BACKGROUND: Many studies associated nosocomial infections with increased hospital costs due to extra days in hospital, staff time, extra investigations and drug treatment. The cost of antibiotic treatment for these infections represents a significant part of hospital expenditure. This prospective observational study was designed to determine the daily antibiotic cost of nosocomial infections per infected adult patient in Akdeniz University Hospital. METHODS: All adult patients admitted to the ICUs between January 1, 2000, and June 30, 2003 who had only one nosocomial infection during their stay were included in the study. Infection sites and pathogens, antimicrobial treatment of patient and it's cost were recorded. Daily antibiotic costs were calculated per infected patient. RESULTS: Among the 8460 study patients, 817 (16.6%) developed 1407 episodes of nosocomial infection. Two hundred thirty three (2.7%) presented with only one nosocomial infection. Mean daily antibiotic cost was $89.64. Daily antibiotic cost was$99.02 for pneumonia, $94.32 for bloodstream infection,$94.31 for surgical site infection, $52.37 for urinary tract infection, and$162.35 for the other infections per patient. The treatment of Pseudomonas aeruginosa infections was the most expensive infection treated. Piperacillin-tazobactam and amikacin were the most prescribed antibiotics, and meropenem was the most expensive drug for treatment of the nosocomial infections in the ICU. CONCLUSIONS: Daily antibiotic cost of nosocomial infections is an important part of extra costs that should be reduced providing rational antibiotic usage in hospitals

Family meetings for older adults in intermediate care settings: the impact of patient cognitive impairment and other characteristics on shared decision making

Background: Clinicians, older adults and caregivers frequently meet to make decisions around treatment and lifestyle during an acute hospital admission. Patient age, psychological status and health locus of control (HLC) influence patient preference for consultation involvement and information but overall, a shared‐decision‐making (SDM) approach is favoured. However, it is not known whether these characteristics and the presence of cognitive impairment influence SDM competency during family meetings. Objective: To describe meetings between older adults, caregivers and geriatricians in intermediate care and explore patient and meeting characteristics associated with a SDM communication style. Methods: Fifty‐nine family meetings involving geriatricians, patients in an intermediate care setting following an acute hospital admission and their caregivers were rated using the OPTION system for measuring clinician SDM behaviour. The geriatric depression scale and multidimensional HLC scale were completed by patients. The mini‐mental state exam (MMSE) assessed patient's level of cognitive impairment. Results: Meetings lasted 38 min (SD 13) and scored 41 (SD 17) of 100 on the OPTION scale. Nine (SD 2.2) topics were discussed during each meeting, and most were initiated by the geriatrician. Meeting length was an important determinant of OPTION score, with higher SDM competency displayed in longer meetings. Patient characteristics, including MMSE, HLC and depression did not explain SDM competency. Conclusion: Whilst SDM can be achieved during consultations frail older patients and their caregivers, an increased consultation time is a consequence of this approach.Catherine M. Milte, Julie Ratcliffe, Owen Davies, Craig Whitehead, Stacey Masters and Maria Crott

Antimicrobial Prophylaxis in Surgery: A Cross Sectional Study

Approximately 33 percent of patients receive an antimicrobial drug during hospitalization and about 33 percent of this group receive the drugs for surgical prophylaxis. The relatively common use of antimicrobial drugs for prophylaxis in hospital practice prompted a more detailed analysis. In this cross sectional study we monitored 245 patients undergoing surgical operation and investigated whether the patient received antimicrobial prophylaxis. If so which antibiotic has been chosen, timing of administiration, administiration route and duration of prophylaxis were followed. Antimicrobial prophylaxis was given to 26% of the clean surgical procedures, 69% of the clean-contaminated surgical procedures and 63% of the contaminated surgical procedures. Cefazolin was the most common chosen antibiotic (38 procedures). The percentage of early operative antibiotic prophylaxis was 24%, preoperative 22%, perioperative 13% and postoperative 41%. A single dose was given to the 9% of the patients, 19% of the patients received antibiotic prophylaxis for 24 hours and 71% received more than 24 hours. IV administiration used in 74%, peroral administiration in 22% and IM in 4%. The percentage of the patients that were given preoperative antibiotic, (IV administiration and not exceeded 24 hours) that were recommended by many authors was only 9%. Although inappropriate use of antimicrobial agents for surgical prophylaxis is very high, we may overcome this problem by getting the appropriate antibiotics in stocks in the operating room, preparing prophylaxis protocols and by contuinuous education

Aeromonas veronii biovar sobria Infection in a Febrile Neutropenic Patient

A 49-year old man who was sent to our hospital because of high fever, cellulitis at left arm and pancytopenia was diagnosed as neutropenic fever, and treatment with imipenem 4 x 500 mg intravenous (IV) and clindamycin 4 x 600 mg IV was started immediately after the cultures were taken. The patient had been followed up for type 2 diabetes mellitus for ten years, and after our clinical and laboratory examinations he was diagnosed as acute myeloid leukemia (AML). Aeromonas veronii biovar sobria was isolated as the agent of cellulitis at the left arm after trauma. As the microorganism was sensitive to imipenem, treatment according to antimicrobial susceptibility test, the present treatment was continued. The patient whose general condition worsened at the follow up died despite all supportive treatment

Candidemia in Akdeniz University Hospital and Predictors of Mortality

Blood-stream infections due to Candida species are important causes of morbidity and mortality in hospitalized patients. We conducted a prospective study of patients with candidemia at Akdeniz University Hospital, between 01 March 2002 and 01 March 2003 and predictors of mortality were investigated. Thirty-five consecutive patients with candidemia identified by at least one positive blood culture. Risk factors for candidemia that previously described in literature as central venous catheters (86%), multiple broad-spectrum antibiotics (82%), urinary catheters (71%), parenteral nutrition (60%) found in our patients. C. albicans was the most frequently isolated species (60%). Overall mortality was 57%. In univariate analysis, mortality was significantly associated with the presence of central venous catheters (p= 0.009), stay in intensive care unit (p= 0.016) and prolonged use mechanical ventilator (p= 0.036). In multivariate logistic regression; mortality was not statistically significant associated with any risk factors in patient with candidemia. It may be related to small sample size

Bacteremia Caused by Chryseobacterium indologenes in a Patient with High Grade Non-Hodgkin Lymphoma

We report a case of bacteremia caused by Chryseobacterium indologenes in a patient who was treated due to the non-Hodgkin lymphoma and developed neutropenia and fever. According to the antimicrobial susceptibility test result, ciprofloxacin was added to the treatment. On the 10th day of the treatment a good response was achieved and the patient discharged after complete recovery

Psoas Abscess Due to Aeromonas hydrophila: Case Report

Forty-one years old male patient who was operated on with the diagnosis of acute necrotizing pancreatitis admitted with probable intraabdominal infection. We determined psoas abscess which fistulized to the skin of abdominal wall by radiological examinations. As Aeromonas hydrophila was isolated from the pus, the patient was evaluated for the risk factors. Intraabdominal infection was treated by imipenem during three weeks without any surgical intervention. The patient remained symptomless during three months follow up. The case was presented because of the unusual psoas abscess which was caused by A. hydrophila

Risk Factors for Postoperative Mediastinitis After Open Heart Surgery

At the Cardiac Surgery Department of the Akdeniz University Hospital, between 1993 and 1999, postoperative mediastinitis developed in 20 of 1476 patients who had underwent open-heart surgery; the incidence was found to be 13%. These cases were analyzed in a case-control study designed to identify risk factors for postoperative mediastinitis. The following significant risk factors were identified; as preoperative factors: History of diabetes mellitus, functional class IV, preoperative prolonged (> 3 days) antibiotic use, as postoperative factors: Prolonged stay in the intensive-care unit, prolonged central venous catheterization and reoperation. Type and duration of surgery were not significantly associated with postoperative mediastinitis. All patients with postoperative mediastinitis had purulent discharge on surgical wound, and other clinical manifestations were fever, sternal dehiscence and sternal pain. The mortality rate was 20% (4 of 20) among the patients with mediastinitis. All patients were treated with extensive debridement and long term parenteral antibiotics

Case Report: Colistin Use in the Treatment of Multidrug Resistant Pseudomonas aeruginosa

Twenty years old male patient who had hod brain tumor and hydrocephalus was referred to our clinic because of ventriculo-peritoneal shunt (VPS) infection. Klebsiella pneumoniae (ESBL negative) and Staphylococcus aureus (MSSA) were isolated from cerebrospinal fluid (CSF) and blood culture respectively, cefepime and amikacin were initiated. Multidrug resistant Pseudomonas aeruginosa was isolated from CSF during antibiotic therapy. The microorganism was resistant to third and fourth generation antipseudomonal cephalosporins, antipseudomonal penicillin + beta-lactamase inhibitor combination, quinolons, carbapenems, aminoglycosides by E-test and intravenous colistin was started (later intrathecal too). During this treatment multidrug resistant P. aeruginosa continued to be isolated. Therefore we removed the VPS and continued colistin therapy. CSF cultures were sterile in the controls. There was no side effects and the drug was good tolerated. The therapy cost was 33.6 Deutche Mark (DM) per day. Colistin, which is not marketed in our country, can be an alternative in the treatment of gram-negative microorganisms, which are resistant to other antimicrobials

Respiratory Syncytial Virus Pneumonia During Febrile Neutropenia and Its Treatment

Twenty-four years old male who had chronic myelocytic leukemia (CML) for eight months, was admitted to emergency unit because of fatigue, palpitation, dyspnea and fever. He was hospitalized because of blastic transformation from CML to acute myelocytic leukemia (AML) and also febrile neutropenia. Respiratory distress and hypotension occurred and respiratory syncytial virus (RSV) pneumonia was laboratorally diagnosed. He responded to the oral ribavirin therapy but he died because of a new febrile neutropenic episode and bleeding. This case is the first reported RSV pneumonia in a febrile neutropenic patient and its treatment choices are limited in our country