From November 1996 through March 1997, presumptive active pulmonary tuberculosis (TB) was detected in 44 health care workers (HCWs) at a university hospital in Lima, Peru. To further assess the magnitude of the outbreak and determine risk factors for occupational Mycobacterium tuberculosis transmission, we identified HCWs in whom active pulmonary TB was diagnosed from January 1994 through January 1998, calculated rates by year and hospital work area, and conducted a tuberculin skin test (TST) survey. Thirty-six HCWs had confirmed active pulmonary TB. The rate of TB was significantly higher among the 171 HCWs employed in the laboratory than among HCWs employed in all other areas. In multivariate analysis, the only independent risk factor for HCW M. tuberculosis infection in HWCs employed in the laboratory was the use of common staff areas. Very high rates of active pulmonary TB were detected among HCWs at this hospital, and occupational acquisition in the laboratory was associated with HCW-to-HCW transmission.

Las cardiopatías congénitas han cobrado importancia en las últimas décadas, no solo por su relevancia clínica sino también por su incremento como problema de salud pública. En nuestro país, pese a los avances en el manejo médico, no se ha realizado estudios que determinen la importancia epidemiológica de este grupo de problemas. Objetivo: Determinar la importancia epidemiológica de las cardiopatías congénitas. Diseño: Sistematización de estudios epidemiológicos. Lugar: Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina de San Fernando, UNMSM. Materiales: Estudios epidemiológicos e información demográfica. Procedimiento: Mediante una recopilación bibliográfica de estudios epidemiológicos e información demográfica, se realizó estimaciones de la incidencia de casos en nuestro país, para el quinquenio 2006-2010. Principales medidas de resultados: Cardiopatías congénitas. Resultados: Se estima que en el 2006 existieron 3 925 cardiopatías, de las cuales 83,5% fueron no cianóticas. Las cifras serían similares anualmente hasta el 2010. También, se estima que representarían el 2,5% del total de razón de años de vida potencialmente perdidos por cada mil habitantes. Conclusiones: Las cardiopatías congénitas son un problema de salud pública que debe ser tomada en cuenta para preparar a los servicios nacionales de salud. Asimismo, debe emprenderse estudios epidemiológicos sobre este problema.

A829Generalized linear regression models were used to examine associations between the total cost of hospitalization and various sociodemographic and clinical variables. Results: 301 patients were included; age 75.3 ± 11.8 years; 37% female; 57% with depressed ejection fraction; 46% of coronary artery disease. The blood pressure on admission was 129.8 ± 29.7 mmHg; renal function 26.2 ± 57.9 ml / min / 1.73 m2. In-hospital mortality was 7%. The length of stay was 7.82 ± 7.06 days (median 5.69), more prolonged in patients with renal impairment (8.59 vs. 8.18; p = 0.0329) and shorter in those with elevated blood pressure on admission (6.08 ± 4.03; p = 0.009). The average cost per patient was AR $ 68,861 ± 96,066 (US $ 8,071 ± 11,259; US $ 1 = AR $ 8.7928); 71% attributable to hospital stay, 20% for therapeutic procedures (mainly aortic valve surgery, implanted defibrillator and coronary angioplasty) and 6.7% for diagnostic studies (mainly radiology, laboratory and echocardiogram). In multivariate analysis, depressed ejection fraction, valve antecedent and impaired renal function at admission were associated with higher costs. ConClusions: Resource use and costs associated hospitalizations for heart failure are high, and the highest proportion is attributable to the costs of hospital stay.

A133hospitalized for ≥ 2 days (hospitalized patients; HPs), or using emergency room (ER) or observation for 1 day (emergency room patients; ERPs). Reimbursements were based on claims and inflated to 2010 USD; costs were derived from 2010 Premier data. Net reimbursement was analyzed by MS-DRG and length of stay (LOS). The risk of all-cause hospitalization and factors correlated with LOS were determined using regression modeling. Results: Across all study years, the median age was 71 for HPs, 65 for ERPs. Median Charlson Comorbidity Index (CCI) was 4 for HPs and 2 for ERPs. HPs had more cellulitis on the leg or surgical infection; ERPs had more cellulitis on the face, trunk, or arm. Median HP LOS was 4 days; 33% of patients had LOS > 6 days. Age, race, and history of bacterial infection were correlated with LOS. Median all-cause, ABSSSI-related and index event costs during the index quarter for patients with a principle ABSSSI diagnosis were $9,930, $6,123 and $5,604 for HPs and $1,127, $108 and $100 for ERPs respectively. ConClusions: HPs were older and sicker than ERPs, with more cellulitis on the leg and post-operative infections. Further research and analysis may help determine whether treating some hospitalized patients with less comorbidity in the ambulatory setting might result in lower costs per patient after controlling for these factors.