Nosocomial infections among acute leukemia patients in China: An economic burden analysis

Wu, Xiaohui; Yan, Tianyuan; Liu, Yunhong; Wang, Jingna; Li, Yingxia; Wang, Shuhui

doi:10.1016/j.ajic.2016.03.072

Cited by 7 publications

(1 citation statement)

References 23 publications

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“…Each year, millions of hospitalizations are complicated by healthcare-associated infections (HAIs) [ 1 ], which increase morbidity and mortality rates, prolong hospital stays, and substantially inflate the cost of medical care [ 2 – 5 ]. Newborns in neonatal intensive care units (NICUs) are a vulnerable population at increased risk due to their low birth weight, prematurity, and exposure to numerous invasive procedures [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

Bourdin,

Benoit,

Prévost

et al. 2024

PLoS ONE

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Objective Evaluate the effects of five disinfection methods on bacterial concentrations in hospital sink drains, focusing on three opportunistic pathogens (OPs): Serratia marcescens, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Design Over two years, three sampling campaigns were conducted in a neonatal intensive care unit (NICU). Samples from 19 sink drains were taken at three time points: before, during, and after disinfection. Bacterial concentration was measured using culture-based and flow cytometry methods. High-throughput short sequence typing was performed to identify the three OPs and assess S. marcescens persistence after disinfection at the genotypic level. Setting This study was conducted in a pediatric hospitals NICU in Montréal, Canada, which is divided in an intensive and intermediate care side, with individual rooms equipped with a sink. Interventions Five treatments were compared: self-disinfecting drains, chlorine disinfection, boiling water disinfection, hot tap water flushing, and steam disinfection. Results This study highlights significant differences in the effectiveness of disinfection methods. Chlorine treatment proved ineffective in reducing bacterial concentration, including the three OPs. In contrast, all other drain interventions resulted in an immediate reduction in culturable bacteria (4–8 log) and intact cells (2–3 log). Thermal methods, particularly boiling water and steam treatments, exhibited superior effectiveness in reducing bacterial loads, including OPs. However, in drains with well-established bacterial biofilms, clonal strains of S. marcescens recolonized the drains after heat treatments. Conclusions Our study supports thermal disinfection (>80°C) for pathogen reduction in drains but highlights the need for additional trials and the implementation of specific measures to limit biofilm formation.

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Section: Introductionmentioning

confidence: 99%

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

Bourdin,

Benoit,

Prévost

et al. 2024

PLoS ONE

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Application of protein typing in molecular epidemiological investigation of nosocomial infection outbreak of aminoglycoside-resistant Pseudomonas aeruginosa

Song

Tang

Ding

et al. 2017

Environ Sci Pollut Res

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Pseudomonas aeruginosan has emerged as an important pathogen elated to serious infections and nosocomial outbreaks worldwide. This study was conducted to understand the prevalence of aminoglycoside (AMG)-resistant P. aeruginosa in our hospital and to provide a scientific basis for control measures against nosocomial infections. Eighty-two strains of P. aeruginosa were isolated from clinical departments and divided into AMG-resistant strains and AMG-sensitive strains based on susceptibility test results. AMG-resistant strains were typed by drug resistance gene typing (DRGT) and protein typing. Five kinds of aminoglycoside-modifying enzyme (AME) genes were detected in the AMG-resistant group. AMG-resistant P. aeruginosa strains were classified into three types and six subtypes by DRGT. Four protein peaks, namely, 9900.02, 7600.04, 9101.25 and 10,372.87 Da, were significantly and differentially expressed between the two groups. AMG-resistant P. aeruginosa strains were also categorised into three types and six subtypes at the distance level of 10 by protein typing. AMG-resistant P. aeruginosa was cloned spread in our hospital; the timely implementation of nosocomial infection prevention and control strategies were needed in preventing outbreaks and epidemic of AMG-resistant P. aeruginosa. SELDI-TOF MS technology can be used for bacterial typing, which provides a new method of clinical epidemiological survey and nosocomial infection control.

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Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into account

Heister

Kaier

Wolkewitz

2017

American Journal of Infection Control

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We read with interest 2 recent articles by Wu et al 1 and Judd et al 2 about the economic burden of nosocomial infections (NIs). Wu et al investigated the economic impact of infections in patients with acute leukemia in China. Although much research has been published on the burden of NI, most of it has focused on high-income countries. However, many limited-resource countries experience high rates of NIs, which likely present a large burden on the respective health care system. 3 To accurately evaluate the cost-effectiveness of interventions aimed at NI in these settings, more research in this field is therefore duly needed. However, we would like to stress the importance of considering the methodologic particularities in the analysis of the economic burden of NI, which substantially influence the estimation. In particular, ignoring the time-dependent nature of hospitalacquired infections can lead to a considerable overestimation of the length of stay and consequently the cost attributable to NI. 4 Hospital-acquired infections occur per definition after admission during the hospital stay and are therefore a time-dependent exposure. Comparing patients that acquire NI with patients without NI on the basis of overall length of stay therefore leads to timedependent bias because only extra length of stay postinfection should be attributed to the infection. 5 Even controlling for all relevant confounders at baseline cannot reduce this bias because it stems from the temporal dynamics of the exposure variable. To account for the time dependency of the exposure, multistate models or time-to-infection matching are advocated. 6 Hence, this bias could have been prevented by further matching on preinfection length of stay. By ignoring this time dependency, Wu et al overestimated the economic impact of hospital-acquired infections in patients with leukemia. A recent systematic review on the magnitude of the time-dependent bias found that conventional methods can lead to an overestimation of the extra length of stay between 33% and 731%, or 2-28 days, depending on infection type and method. 4 However, the investigated studies are exclusively for high-income countries and may differ for limited resource settings such as China.Another aspect of estimating the burden of NIs is that inhospital costs are highly clustered within procedural groups because of the high amount of procedure-related fixed costs. This is espe-cially true in countries with a diagnosis-driven reimbursement system (eg, Diagnosis Related Group reimbursement systems), where it may be expected that reimbursement-driven discharge management is applied. 7 Wu et al 1 did not face this problem because acute leukemia (a single diagnostic group) was the central inclusion criteria. Another recent article, however, was confronted with both the aforementioned time dependency and the problem of clustering within procedural groups: Judd et al estimated the excess length of stay and costs of resistance among patients with documented Pseudomonas aeruginosa infection. Inste...

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Nosocomial infections among acute leukemia patients in China: An economic burden analysis

Cited by 7 publications

References 23 publications

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit

Application of protein typing in molecular epidemiological investigation of nosocomial infection outbreak of aminoglycoside-resistant Pseudomonas aeruginosa

Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into account

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