scholarly journals Mortality, Length of Stay, and Healthcare Costs Associated With Multidrug-Resistant Bacterial Infections Among Elderly Hospitalized Patients in the United States

2021 ◽  
Author(s):  
Richard E Nelson ◽  
David Hyun ◽  
Amanda Jezek ◽  
Matthew H Samore
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Healthcare Costs ◽  
The United States ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Invasive Infections ◽  
Mortality Estimates

Abstract Background This study reports estimates of the healthcare costs, length of stay, and mortality associated with infections due to multidrug-resistant bacteria among elderly individuals in the United States. Methods We conducted a retrospective cohort analysis of patients aged ≥65 admitted for inpatient stays in the Department of Veterans Affairs healthcare system between 1/2007–12/2018. We identified those with positive cultures for multidrug-resistant bacteria and matched each infected patient to ≤10 control patients. We then performed multivariable regression models to estimate the attributable cost and mortality due to the infection. We also constructed multistate models to estimate the attributable length of stay due to the infection. Finally, we multiplied these pathogen-specific attributable cost, length of stay, and mortality estimates by national case counts from hospitalized patients in 2017. Results Our cohort consisted of 87 509 patients with infections and 835 048 matched controls. Costs were higher for hospital-onset invasive infections, with attributable costs ranging from $22 293 (95% confidence interval: $19 101–$24 485) for methicillin-resistant Staphylococcus aureus (MRSA) to $57 390 ($34 070–$80 710) for carbapenem-resistant (CR) Acinetobacter. Similarly, for hospital-onset invasive infections, attributable mortality estimates ranged from 14.2% (12.2–16.2%) for MRSA to 24.1% (12.1–36.0%) for CR Acinetobacter. The aggregate cost of these infections was an estimated $1.9 billion ($1.3 billion–$2.5 billion) with 11 852 (8719–14 985) deaths and 448 224 (354 513–541 934) inpatient days in 2017. Conclusions Efforts to prevent these infections due to multidrug-resistant bacteria could save a significant number of lives and healthcare resources.

scholarly journals Exploration of the Pharmacokinetic-Pharmacodynamic Relationships for Fosfomycin Efficacy Using anIn VitroInfection Model

2015 ◽  
Vol 59 (12) ◽  
pp. 7170-7177 ◽  
Author(s):  
Brian D. VanScoy ◽  
Jennifer McCauley ◽  
Evelyn J. Ellis-Grosse ◽  
Olanrewaju O. Okusanya ◽  
Sujata M. Bhavnani ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Multidrug Resistant ◽  
Dose Fractionation ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Content Type ◽  
E Coli ◽  
Drug Concentrations ◽  
Tract Infections

ABSTRACTFosfomycin, a phosphonic class antibiotic with a broad spectrum of antibacterial activity, has been used outside the United States since the early 1970s for the treatment of a variety of infections. In the United States, an oral (tromethamine salt) formulation is used for uncomplicated urinary tract infections. Recently, there has been interest in the use of an intravenous solution (ZTI-01) for the treatment of a broad range of infections associated with multidrug-resistant bacteria. In this era of multidrug-resistant bacteria with few treatment options, it is critical to understand the pharmacokinetic-pharmacodynamic (PK-PD) determinants for fosfomycin efficacy. Since such data are limited, a one-compartmentin vitroinfection model was used to determine the PK-PD index associated with efficacy and the magnitude of this measure necessary for various levels of effect. One challenge isolate (Escherichia coliATCC 25922, for which the fosfomycin agar MIC is 0.5 mg/liter and the broth microdilution MIC is 1 mg/liter) was evaluated in the dose fractionation studies, and two additional clinicalE. coliisolates were evaluated in the dose-ranging studies. Mutation frequency studies indicated the presence of an inherently fosfomycin resistantE. colisubpopulation (agar MIC = 32 to 64 mg/liter) within the standard starting inoculum of a susceptibility test. Due to the presence of this resistant subpopulation, we identified the percentage of the dosing interval that drug concentrations were above the inherent resistance inhibitory concentration found at baseline to be the PK-PD index associated with efficacy (r2= 0.777). The magnitudes of this PK-PD index associated with net bacterial stasis and 1- and 2-log10CFU/ml reductions from baseline at 24 h were 11.9, 20.9, and 32.8, respectively. These data provide useful information for modernizing and optimizing ZTI-01 dosing regimens for further study.

scholarly journals Epidemiology and Factors Affecting Mortality of Hospitalized Patients with Disseminated Intravascular Coagulation in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2404-2404
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Appalanaidu Sasapu
Keyword(s):  
United States ◽  
African Americans ◽  
Native Americans ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Disseminated Intravascular Coagulation ◽  
The United States ◽  
Hospitalized Patients ◽  
Northeast Region ◽  
Intravascular Coagulation

Introduction Disseminated Intravascular Coagulation (DIC) is a systemic coagulopathy which leads to widespread thrombosis and hemorrhage and ultimately results in multiorgan dysfunction. DIC usually occurs as a complication of illnesses like severe sepsis, malignancies, trauma, acute pancreatitis, burns, and obstetrical complications. The prognosis and mortality of DIC depend on the etiology, however, the mortality of DIC is known to be on the higher side. The aim of the study is to analyze if gender, race, regional differences have any association with the mortality of hospitalized patients with DIC. Method The National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) for the year 2016 was queried for data. We identified hospital admissions for DIC with the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code D65. The data was analyzed with STATA 16.0 version and univariate and multivariate analysis were performed. We studied the characteristics of all such hospitalizations for the year 2016 and the factors associated with the in-hospital mortality rate (MR) of DIC. We used length of stay, cost of stay as an outcome to determine if gender, race, and location play a role in the mortality. Results A total of 8704 admissions were identified with a diagnosis of DIC during the year 2016. The mean age for admission was found to be 56.48± 0.22. The percentage of admissions in females and males did not have a notable difference (50.57% vs 49.43%). The disease specific MR for DIC was 47.7%. Admission during weekend vs weekdays did not carry a statistically significant difference in terms of MR. Females with DIC were less likely to die in the hospital when compared to males with DIC (OR= 0.906, CI 0.82 - 0.99, p= 0.031). Interestingly, African Americans (AA) with DIC admissions were found to have 24% more risk of dying when compared to Caucasians admitted with DIC (OR= 1.24, CI 1.10 - 1.39, P= 0.00), Native Americans (NA) has 67% more risk of dying when compared to Caucasians (OR= 1.67, CI 1.03 - 2.69, p= 0.035). The mortality rate of NA, AA, Caucasians with DIC was found to be 57%, 52%, 47% respectively. The MR was found to be highest in hospitals of the northeast region (52%), then hospitals in the south (47%), followed by west and mid-west (46%), p= 0.000. Patients admitted to west and mid-west were 24% less likely to die when compared to patients admitted to northeast region hospitals (OR= 0.76, p= 0.001). The average length of stay and cost of stay were also less in west and mid-west regions when compared to north east. The difference in outcomes persisted after adjusting for age, gender, race, hospital division, co-morbid conditions. Conclusion Our study demonstrated that African Americans and Native Americans with DIC have high risk of dying in the hospital. Also, there exists a difference between the mortality rate, length and cost of stay among different regions in the United States. More research is needed to elucidate the factors that might be impacting the location-based variation in mortality. Disclosures No relevant conflicts of interest to declare.

scholarly journals A Whole-Cell Screen Identifies Small Bioactives That Synergize with Polymyxin and Exhibit Antimicrobial Activities against Multidrug-Resistant Bacteria

2019 ◽  
Vol 64 (3) ◽  
Author(s):  
Shawn M. Zimmerman ◽  
Audrey-Ann J. Lafontaine ◽  
Carmen M. Herrera ◽  
Amanda B. Mclean ◽  
M. Stephen Trent
Keyword(s):  
Bacterial Infections ◽  
Large Scale ◽  
The United States ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Synergistic Activity ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Eskape Pathogens

ABSTRACT The threat of diminished antibiotic discovery has global health care in crisis. In the United States, it is estimated each year that over 2 million bacterial infections are resistant to first-line antibiotic treatments and cost in excess of 20 billion dollars. Many of these cases result from infection with the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), which are multidrug-resistant bacteria that often cause community- and hospital-acquired infections in both healthy and immunocompromised patients. Physicians have turned to last-resort antibiotics like polymyxins to tackle these pathogens, and as a consequence, polymyxin resistance has emerged and is spreading. Barring the discovery of new antibiotics, another route to successfully mitigate polymyxin resistance is to identify compounds that can complement the existing arsenal of antibiotics. We recently designed and performed a large-scale robotic screen to identify 43 bioactive compounds that act synergistically with polymyxin B to inhibit the growth of polymyxin-resistant Escherichia coli. Of these 43 compounds, 5 lead compounds were identified and characterized using various Gram-negative bacterial organisms to better assess their synergistic activity with polymyxin. Several of these compounds reduce polymyxin to an MIC of <2 μg/ml against polymyxin-resistant and polymyxin-heteroresistant Gram-negative pathogens. Likewise, four of these compounds exhibit antimicrobial activity against Gram-positive bacteria, one of which rapidly eradicated methicillin-resistant Staphylococcus aureus. We present multiple first-generation (i.e., not yet optimized) compounds that warrant further investigation and optimization, since they can act both synergistically with polymyxin and also as lone antimicrobials for combating ESKAPE pathogens.

scholarly journals POS0012 EPIDEMIOLOGY OF FIBROMYALGIA HOSPITALIZATIONS IN THE UNITED STATES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 208.2-208
Author(s):  
K. Mathias ◽  
A. Mantha ◽  
L. Mathias ◽  
D. Arkfeld
Keyword(s):  
Rheumatoid Arthritis ◽  
United States ◽  
Length Of Stay ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Cost Of Care ◽  
Classification Criteria ◽  
Hospitalized Patients ◽  
National Inpatient Sample ◽  
Tender Points

Background:Fibromyalgia is a chronic pain syndrome that is associated with protean symptoms including musculoskeletal pain, psychiatric symptoms, cognitive dysfunction, memory difficulty, and sleep disturbance. Fibromyalgia can be a primary diagnosis, or it can be associated with other conditions. Fibromyalgia is often seen in conjunction with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. In 1990, the American College of Rheumatology released classification criteria for fibromyalgia that included symptoms of diffuse pain and physical exam findings of at least 11 of 18 defined tender points. In 2010, the ACR updated these criteria and eliminated the requirement of tender points. In 2011, these criteria were further modified to that they could be self-administered. A previous study used the national inpatient sample to examine hospitalization data for patients with fibromyalgia from 1999-2007. 1 No studies, however, have examined this data since the new ACR criteria were established in 2010.Objectives:We aim to characterize the epidemiology of hospitalized patients with diagnosis of fibromyalgia.Methods:Hospitalized patients with a diagnosis of fibromyalgia were identified in the 2016-2018 National Inpatient Sample (NIS) using the International Classification of Diseases 10 system (ICD-10). The NIS is an all-payer inpatient database that estimates over 37 million annual U.S. hospitalizations and is maintained by the Healthcare Cost and Utilization Project. The primary outcomes were prevalence of fibromyalgia and comorbid rheumatologic conditions among hospitalized patients. Secondary outcomes included cause of admission, mortality, length of stay, and cost of care.Results:Of 1,351,234 patients with fibromyalgia identified, 437,145 were admitted in 2016 increasing to 461,820 in 2018. On average 59.1 years old, more likely female (1,262,735, 93.5%) and white (1,060,845, 81.3%). Patients were most likely to have Medicare (775,420, 57.5%) and were in the bottom quartile of income (402,945, 30.3%). The most common rheumatologic comorbidities were rheumatoid arthritis (142,195, 10.5%), lupus (69,980, 5.2%), and inflammatory bowel disease (38,165, 2.2%). Notably fibromyalgia was commonly associated with depression (500,420, 37.0%), obesity (379,324, 28.1%), hypothyroidism (334,585 24.7%), and congestive heart failure (213,790, 15.8%).The mortality rate was 13,605 (1.0%) patients, the average length of stay was (4.53 days), and the average cost of hospitalization ($12,522). The most common causes of admission were inflammatory syndromes and joint disorders (13.4%) of which OA (4.2%) was most common complaint, digestive complaints (12.1%) of which IBD (4.4%) was most common.Conclusion:The yearly number of fibromyalgia hospital discharges were greater than previously described. This may be a result of a more sensitive classification criteria. Further investigation into the etiology of this increase in fibromyalgia hospitalization diagnosis is warranted.References:[1]Haviland MG, Banta JE, Przekop P. Fibromyalgia: prevalence, course, and co-morbidities in hospitalized patients in the United States, 1999-2007. Clin Exp Rheumatol. 2011 Nov-Dec;29(6 Suppl 69):S79-87. Epub 2012 Jan 3. PMID: 22243553.Disclosure of Interests:None declared.

scholarly journals Effectiveness of essential oil from the Artemisia herba-alba aerial parts against multidrug-resistant bacteria isolated from food and hospitalized patients

2021 ◽  
Vol 22 (7) ◽  
Author(s):  
Abdelaziz Ed-Dra ◽  
Fouzia Rhazi Filali ◽  
Vittorio Lo Presti ◽  
Badr Zekkori ◽  
Luca Nalbone ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Gas Chromatography ◽  
Antioxidant Activity ◽  
Essential Oil ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
World Health ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Aerial Parts

Abstract. Ed-Dra A, Filali FR, Presti VL, Zekkori B, Nalbone L, Elsharkawy ER, Bentayeb A, Giarrtana F. 2021. Effectiveness of essential oil from the Artemisia herba-alba aerial parts against multidrug-resistant bacteria isolated from food and hospitalized patients. Biodiversitas 22: 2995-3005. The World Health Organization has sounded the warning on the diffusion of multidrug resistance (MDR) bacteria, requiring solutions and alternatives to solve the therapeutic failure that may occur. This study aims to evaluate the antioxidant activity and bactericidal effectiveness against MDR bacteria of Artemisia herba-alba essential oil (A-EO) collected from semi-arid region of Morocco. Chemical composition of the A-EO was determined by Gas Chromatography-Flame Ionisation Detector and Gas Chromatography-Mass Spectrometry, while the antioxidant activity was performed by DPPH scavenging activity and ?-carotene bleaching assay. Antibacterial activity of A-EO, performed by disc diffusion assay and broth dilution method, was tested against: four MDR strains (Escherichia coli, Staphylococcus aureus, Salmonella Typhimurium and Enterococcus faecalis) isolated from food matrices, two (Klebsiella pneumonia and Pseudomonas aeruginosa) from hospitalized patients, and Escherichia coli ATCC 25922 as reference strain. Davanone was the main compound among the 17 identified. An antioxidant activity with IC50 of 1.13±0.02 mg/mL, EC50 of 2.12±0.05 mg/mL and RC50 of 0.87±0.02 mg/mL was observed. A weak activity against P. aeruginosa was observed, while it was intermediate or high against the other bacteria. This study confirms that A-EO could be a suitable alternative to antibiotics in the infection treatment related to MDR bacteria.

scholarly journals Antimicrobial resistance in Salmonella that caused foodborne disease outbreaks: United States, 2003–2012

2016 ◽  
Vol 145 (4) ◽  
pp. 766-774 ◽  
Author(s):  
A. C. BROWN ◽  
J. E. GRASS ◽  
L. C. RICHARDSON ◽  
A. L. NISLER ◽  
A. S. BICKNESE ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Disease Outbreaks ◽  
The United States ◽  
Food Group ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Foodborne Disease ◽  
Susceptibility Data ◽  
Invasive Infections

SUMMARYAlthough most non-typhoidal Salmonella illnesses are self-limiting, antimicrobial treatment is critical for invasive infections. To describe resistance in Salmonella that caused foodborne outbreaks in the United States, we linked outbreaks submitted to the Foodborne Disease Outbreak Surveillance System to isolate susceptibility data in the National Antimicrobial Resistance Monitoring System. Resistant outbreaks were defined as those linked to one or more isolates with resistance to at least one antimicrobial drug. Multidrug resistant (MDR) outbreaks had at least one isolate resistant to three or more antimicrobial classes. Twenty-one per cent (37/176) of linked outbreaks were resistant. In outbreaks attributed to a single food group, 73% (16/22) of resistant outbreaks and 46% (31/68) of non-resistant outbreaks were attributed to foods from land animals (P < 0·05). MDR Salmonella with clinically important resistance caused 29% (14/48) of outbreaks from land animals and 8% (3/40) of outbreaks from plant products (P < 0·01). In our study, resistant Salmonella infections were more common in outbreaks attributed to foods from land animals than outbreaks from foods from plants or aquatic animals. Antimicrobial susceptibility data on isolates from foodborne Salmonella outbreaks can help determine which foods are associated with resistant infections.

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