scholarly journals Routine blood cultures in the management of community acquired pneumonia; is it necessary?

2013 ◽  
Vol 1 (2) ◽  
pp. 54-57
Author(s):  
TM Ibrahim
Keyword(s):  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
True Positive ◽  
It Use ◽  
The Cost

INTRODUCTION: The role of blood cultures (BCs) in the management of community acquired pneumonia (CAP) has generated a lot of controversy among clinicians in recent times. The main objectives of this audit were to determine if BC results impact the choice of antibiotics, and hospital outcomes in CAP. MATERIALS AND METHODS: This was a retrospective study of adults with CAP treated in the ED of Goulbourn Valley Base Hospital, Shepparton in Australia from November 2010 to November 2011. RESULTS: Two hundred and twenty five patients were treated for CAP during the period in review with a mean age of 67.09±19.82 yrs and male:female of 1.5:1. 277 sets of BCs were performed and only 2.2% of the cases had true positive BCs .87% of the total cost of performing these BCs was spent on those with negative cultres.15.1% of the cases had their antibiotics changed during their hospitalization but the results of the BCs had no impact on the antibiotic change. Even though not statistically significant true positive BCs was associated with prolong length of hospital stay (7.6 ± 9.39 days vs 4.89 ± 3.24 days, p=0.44), and duration of IV antibiotic use (4.8±3.27 days vs 3.58±1.97 days, p=0.39). But the case fatality rate was much lower in those with positive BCs, (0 vs 5.7%,p< 0.05). Tachycardia (>120.4±12.46 bpm), neutrophilia (15.0± 8.16 /ul), and high CRP (326.4±146.32 ug/l) were predictors of true positive BCs. CONCLUSIONS: Routine BCs in the management of CAP is not cost-effective with large portion of the cost spent on cultures that returned negative result .Therefore it use show be limited to those likely to return positive cultures. DOI: http://dx.doi.org/10.3126/ijim.v1i2.7408 Int J Infect Microbiol 2012;1(1):54-57

scholarly journals Cost-Effectiveness Analysis of Xiyanping Injection (Andrographolide Sulfonate) for Treatment of Adult Community Acquired Pneumonia: A Retrospective, Propensity Score-Matched Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Honghao Shi ◽  
Wanjie Guo ◽  
He Zhu ◽  
Meng Li ◽  
Carolina Oi Lam Ung ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Conventional Treatment ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Daily Practice ◽  
Community Acquired Pneumonia ◽  
Clinical Effects ◽  
Effectiveness Analysis ◽  
Effectiveness Index ◽  
The Cost

Xiyanping injection (andrographolide sulfonate) has shown clinical effects on community acquired pneumonia. However, there is little known about the effectiveness and costs of combining Xiyanping injection with conventional treatment on adult community acquired pneumonia in daily practice. The aim of this study was to evaluate the cost-effectiveness of combining Xiyanping injection with conventional treatment for treatment of adult community acquired pneumonia by comparing with conventional treatment from a societal perspective. Using retrospective cohort method, this study demonstrates that Xiyanping injection combined with conventional treatment is superior to conventional treatment for patients using cephalosporins and antibiotics under the effectiveness index of length of hospital stay and is more cost-effective.

scholarly journals INCREASE IN THE ROLE OF PHARMACIST AS A PROFESSIONAL UNDER THE CONDITIONS OF THE BOLOGNA SYSTEM IN UKRAINE

2014 ◽  
Vol 2 ◽  
pp. 319-322
Author(s):  
Vitaliy Moskalenko ◽  
Iryna Nizhenkovskaya ◽  
Elena Welchinska
Keyword(s):  
Cost Effective ◽  
Healthcare Spending ◽  
Healthcare Management ◽  
Public Health Care ◽  
Public Healthcare ◽  
State Agencies ◽  
High Quality Education ◽  
Technological Advances ◽  
The Cost

Countries worldwide are facing similar healthcare problems.  Medicine develops new methods for treatment, and pharmaceutical companies invent more efficient products.  These technological advances are, however, expensive, and put a double-strain on public healthcare spending: the cost of sophisticated treatment keeps growing, and improved healthcare allows patients to live longer, thus requiring more treatment.  Budgetary constraints, however, require government to restrict expenditure.  These challenges have to be answered in the context of existing public healthcare systems, which, are well established and complex.  Healthcare reforms will necessarily reflect these characteristics, as well as the relative political weight of the partners.  Such reforms will most likely affect all partners involved in the provision and healthcare management, including social security institutions (state agencies, sickness funds, etc.), doctors, and other health professionals—pharmacists.  Currently one of most important strategic tasks of modernization of the system of higher education in Ukraine is the high quality education provided to pharmacists in order to satisfy the worldwide needs.Whatever specific reform will be adopted, the main goals are to make the system more efficient and, thus, more cost effective; and, because the first aspect will not sufficiently decrease the expenditure, it is necessary to limit the scope of public health care while maintaining a balance of benefits.  

scholarly journals Blood Cultures Versus Respiratory Cultures: 2 Different Views of Pneumonia

2019 ◽  
Vol 71 (7) ◽  
pp. 1604-1612 ◽  
Author(s):  
Sarah Haessler ◽  
Peter K Lindenauer ◽  
Marya D Zilberberg ◽  
Peter B Imrey ◽  
Pei-Chun Yu ◽  
...  
Keyword(s):  
Case Fatality ◽  
Empiric Therapy ◽  
Respiratory Arrest ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
First Line ◽  
First Line Therapy ◽  
Lengths Of Stay ◽  
Resistance Patterns ◽  
Source Models

Abstract Background Choice of empiric therapy for pneumonia depends on risk for antimicrobial resistance. Models to predict resistance are derived from blood and respiratory culture results. We compared these results to understand if organisms and resistance patterns differed by site. We also compared characteristics and outcomes of patients with positive cultures by site. Methods We studied adult patients discharged from 177 US hospitals from July 2010 through June 2015, with principal diagnoses of pneumonia, or principal diagnoses of respiratory failure, acute respiratory distress syndrome, respiratory arrest, or sepsis with a secondary diagnosis of pneumonia, and who had blood or respiratory cultures performed. Demographics, treatment, microbiologic results, and outcomes were examined. Results Among 138 561 hospitalizations of patients with pneumonia who had blood or respiratory cultures obtained at admission, 12 888 (9.3%) yielded positive cultures: 6438 respiratory cultures, 5992 blood cultures, and 458 both respiratory and blood cultures. Forty-two percent had isolates resistant to first-line therapy for community-acquired pneumonia. Isolates from respiratory samples were more often resistant than were isolates from blood (54.2% vs 26.6%; P &lt; .001). Patients with both culture sites positive had higher case-fatality, longer lengths of stay, and higher costs than patients who had only blood or respiratory cultures positive. Among respiratory cultures, the most common pathogens were Staphylococcus aureus (34%) and Pseudomonas aeruginosa (17%), whereas blood cultures most commonly grew Streptococcus pneumoniae (33%), followed by S. aureus (22%). Conclusions Patients with positive respiratory tract cultures are clinically different from those with positive blood cultures, and resistance patterns differ by source. Models of antibiotic resistance should account for culture source.

scholarly journals Diagnostic performance of rapid antigen tests (RATs) for SARS-CoV-2 and their efficacy in monitoring the infectiousness of COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
John G. Routsias ◽  
Maria Mavrouli ◽  
Panagiota Tsoplou ◽  
Kyriaki Dioikitopoulou ◽  
Athanasios Tsakris
Keyword(s):  
Diagnostic Performance ◽  
Limit Of Detection ◽  
High Sensitivity ◽  
Cost Effective ◽  
Clinical Samples ◽  
True Positive ◽  
Antigen Tests ◽  
The Cost ◽  
Very High ◽  
Test Result

AbstractThe most widely used test for the diagnosis of SARS-CoV-2 infection is a PCR test. PCR has very high sensitivity and is able to detect very low amounts of RNA. However, many individuals receiving a positive test result in a context of a PCR-based surveillance might be infected with SARS-CoV-2, but they are not contagious at the time of the test. The question arises regards if the cost effective, portable rapid antigen tests (RATs) have a better performance than PCR in identification of infectious individuals. In this direction, we examined the diagnostic performance of RATs from 14 different manufacturers in 400 clinical samples with known rRT-PCR cycles threshold (cT) and 50 control samples. Substantial variability was observed in the limit of detection (LOD) of different RATs (cT = 26.8–34.7). The fluorescence-based RAT exhibited a LOD of cT = 34.7. The use of the most effective RATs leads to true positive rates (sensitivities) of 99.1% and 90.9% for samples with cT ≤ 30 and cT ≤ 33, respectively, percentages that can guarantee a sensitivity high enough to identify contagious patients. RAT testing may also substantially reduce the quarantine period for infected individuals without compromising personal or public safety.

Clinical impact of febrile neutropenia (FN) increase among patients receiving adjuvant docetaxel/cyclophosphamide (TC) chemotherapy compared to TC plus pegfilgrastim for breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1076-1076 ◽  
Author(s):  
Erika Paige Hamilton ◽  
Donna L. Topping ◽  
Jeffrey M. Peppercorn ◽  
P. Kelly Marcom ◽  
Gretchen Genevieve Kimmick ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Routine Care ◽  
Breast Cancer Patients ◽  
Retrospective Reports ◽  
Baseline Characteristics ◽  
The Cost ◽  
To Receive

1076 Background: The FN rate for the approved regimen of TC is 5% in pivotal studies. Other small retrospective reports have reported FN rates as high as 20-35%. We report the incidence of FN from a large retrospective series of breast cancer patients receiving TC with or without pegfilgrastim (PF) for adjuvant therapy. Methods: We reviewed records of 240 sequential patients who had received adjuvant TC (75 and 600 mg/m2) between Mar ’07 and Nov ’12 for FN, upfront PF use, and adverse events by treatment cohort. FN was defined as T> 100.4°F and ANC <500, while upfront PF was defined as PF given at physician discretion 24-48h after 1stcycle of TC administration. Comparisons between two proportions used exact binomial methods; effect of PF on FN after adjusting for baseline characteristics was tested using multivariate logistic regression. Results: 153 (63.7%) patients received upfront PF, while 87 (36.3%) did not (Table). Patients receiving upfront PF were older (57 vs. 52 yrs, p=0.02). Other baseline characteristics (size of primary tumor, hormone receptor status, and nodal status) were no different between groups. FN, fever, antibiotic use, hospitalization, and dose delay were significantly higher when upfront PF was not used (Table). The average length of hospital stay was 2.9 days for TC + PF, and 3.8 days for TC pts. 31/87 (35.6%) of patients without upfront PF went on to receive PF after the 1st cycle. Conclusions: FN for adjuvant TC meets clinical practice threshold and ASCO guidelines for upfront use of PF. FN-related outcomes such as fever, antibiotic use, dose delays, and number of hospitalizations, and were significantly increased without upfront PF. The cost-effectiveness of these findings will be presented and have major clinical implications for routine care. [Table: see text]

scholarly journals Burns infection profile of Singapore: prevalence of multidrug-resistant Acinetobacter baumannii and the role of blood cultures

2016 ◽  
Vol 4 ◽  
pp. 1-9 ◽  
Author(s):  
Christopher Tam Song ◽  
Jolie Hwee ◽  
Colin Song ◽  
Bien Keem Tan ◽  
Si Jack Chong
Keyword(s):  
Hospital Stay ◽  
Acinetobacter Baumannii ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Burn Patients ◽  
Perioperative Antibiotics ◽  
Infection Profile

Abstract Background With various changes implemented such as perioperative antibiotics for tangential excision, this retrospective study reviews the infection profile of burn patients at Singapore’s only centralized burns unit. Worldwide, the appearance of multidrug-resistant (MDR) strains of Acinetobacter baumannii (A. baumannii) continues to worsen patient outcomes. This study also surveys the role of blood cultures in burns at our unit. Methods Four hundred fifty-two burn patients admitted to the unit between 2011 and 2013, and with cultures performed, were included in the study. The yields of various cultures were evaluated and 2684 samples were amassed, of which 984 (36.7 %) were positive. Patient variables for predictors of MDR A. baumannii infection acquisition and bacteremia were evaluated through multivariate analyses. Results Pseuodomonas aeruginosa (P. aeruginosa) (67 patients) was the most common organism in those with total body surface area (TBSA) burn &lt;20 % while MDR A. baumannii (39 patients) was most prevalent in those with TBSA burn ≥20 %. We found a yield of 1.1 % positive blood cultures for TBSA burn &lt;20 % and a yield of 18.6 % positive cultures in TBSA burn ≥20 %. The median time between surgery and bacteremia was 6.5 days (range -18 to 68 days, interquartile range 4.5); 2.9 and 8.8 % of bacteremic episodes occurred within 24 and 48 h, respectively. This is a decrease from a predeceasing study (45.3 % for 24 h and 60 % for 48 h). Multivariate analysis revealed that length of hospital stay and TBSA burn ≥20 % were predictors of MDR A. baumannii infection and positive blood cultures. Conclusions MDR A. baumannii infection burdens patient management, especially in those with TBSA burn ≥20 % and longer hospital stay. Prophylactic antibiotics may reduce perioperative bacteremia, but their role in MDR infections needs to be evaluated. The role of blood cultures in TBSA burn &lt;20 % needs reconsideration.

Cost-effective analysis of conventional and nurse-led clinics for common otological procedures

2004 ◽  
Vol 118 (3) ◽  
pp. 189-192 ◽  
Author(s):  
S. Uppal ◽  
J. Jose ◽  
P. Banks ◽  
E. Mackay ◽  
A. P. Coatesworth
Keyword(s):  
Cost Effective ◽  
Access Time ◽  
Patient Visit ◽  
Complex Patients ◽  
The Difference ◽  
The Cost ◽  
Mean Cost ◽  
Effective Health Care ◽  
Effective Analysis

The need to reduce costs while providing a first-class service has led to the expansion in the role of nurses in recent years. We present results of a comparison of the cost-effectiveness of conventional and nurse-led out-patient ear clinics. Our results indicate that cost-effective health care is a distinct competitive advantage for nurses taking up some roles conventionally performed by doctors. The difference in mean cost of out-patient visit per patient between the two groups is £75.28. This is equivalent to a reduction in cost to the hospital of more than £47000 for the 626 patients seen in a nurse-led ear clinic in a year. The nurse-led service is thus more cost-effective and presents an opportunity by freeing up otolaryngologists’ time to see more complex patients and has the potential for reducing out-patient access time in the NHS.

scholarly journals The role of actigraphy in sleep medicine

2021 ◽  
Author(s):  
Jens G. Acker ◽  
C. Becker-Carus ◽  
Antje Büttner-Teleaga ◽  
Werner Cassel ◽  
Heidi Danker-Hopfe ◽  
...  
Keyword(s):  
Present Article ◽  
Clinical Setting ◽  
Cost Effective ◽  
Sleep Medicine ◽  
Clinical Applications ◽  
Objective Data ◽  
Wide Acceptance ◽  
Wrist Actigraphy ◽  
The Cost

AbstractActigraphy has been used for more than 60 years to objectively measure sleep–wake rhythms. Improved modern devices are increasingly employed to diagnose sleep medicine disorders in the clinical setting. Although less accurate than polysomnography, the chief advantage of actigraphs lies in the cost-effective collection of objective data over prolonged periods of time under everyday conditions. Since the cost of wrist actigraphy is not currently reimbursed, this method has not enjoyed wide acceptance to date. The present article provides an overview of the main clinical applications of actigraphy, including the recommendations of specialist societies.

scholarly journals Reducing blood culture contamination using an initial specimen diversion device

2018 ◽  
Author(s):  
Frederic S. Zimmerman ◽  
Marc V. Assous ◽  
Shoshana Zevin ◽  
Yonit Wiener-Well
Keyword(s):  
Antibiotic Use ◽  
Blood Cultures ◽  
Hospitalized Patients ◽  
True Positive ◽  
Standard Methods ◽  
Initial Specimen ◽  
Significant Difference ◽  
Concomitant Reduction ◽  
Duration Of Hospitalization ◽  
Microbiological Laboratory

AbstractFalse positive blood cultures result from contamination, consuming microbiological laboratory resources and causing unnecessary antibiotic treatment and lengthened hospitalizations. Skin sterilization has been shown to reduce contamination; however, bacteria do not only colonize the surface of human skin, but are also found in deeper tissues, requiring additional techniques to reduce contamination. An initial specimen diversion device diverts the initial 1-2 ml of blood so as to remove any potentially contaminated skin plug, thus potentially further reducing culture contamination. The device has been associated with a reduction in culture contamination over short study periods in certain populations. However, more study is needed to understand whether the effect continues over longer periods of time and in hospitalized patients. Thus, in this prospective, controlled pragmatic study, cultures were obtained from hospitalized patients using the initial specimen diversion device, with cultures taken using standard methods serving as control. In total, 671 blood cultures were obtained: 207 cultures were taken using an initial specimen diversion device, with 2 (1.0%) contaminated cultures and 464 cultures were taken without the device, with 24 (5.2%) contaminated cultures (p < 0.008). No significant difference was shown in the rate of true positive cultures. Thus, use of a diversion device was associated with reduced culture contamination in hospitalized patients over a six month period without concomitant reduction in true positive cultures. This intervention may result in a reduction in costs, antibiotic use and duration of hospitalization.

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