No abstract

ObjectiveThis systematic review sought to assess the costs and benefits of interventions preventing hospital-acquired infections and to evaluate methodological and reporting quality.MethodsWe systematically searched Medline via PubMed and the National Health Service Economic Evaluation Database from 2009 to 2014. We included quasi-experimental and randomized trails published in English or German evaluating the economic impact of interventions preventing the four most frequent hospital-acquired infections (urinary tract infections, surgical wound infections, pneumonia, and primary bloodstream infections). Characteristics and results of the included articles were extracted using a standardized data collection form. Study and reporting quality were evaluated using SIGN and CHEERS checklists. All costs were adjusted to 2013 US$. Savings-to-cost ratios and difference values with interquartile ranges (IQRs) per month were calculated, and the effects of study characteristics on the cost-benefit results were analyzed.ResultsOur search returned 2067 articles, of which 27 met the inclusion criteria. The median savings-to-cost ratio across all studies reporting both costs and savings values was US $7.0 (IQR 4.2–30.9), and the median net global saving was US $13,179 (IQR 5,106–65,850) per month. The studies’ reporting quality was low. Only 14 articles reported more than half of CHEERS items appropriately. Similarly, an assessment of methodological quality found that only four studies (14.8%) were considered high quality.ConclusionsPrevention programs for hospital acquired infections have very positive cost-benefit ratios. Improved reporting quality in health economics publications is required.

No abstract

No abstract

No abstract

No abstract

ObjectiveFrom April 2013 to February 2014 we performed a multicentre prospective cross-sectional study in 541 German nursing home residents. We determined pharyngeal carriage of Streptococcus pneumoniae (primary objective) and other bacteria (secondary objective) in naso- and oropharyngeal swabs by culture-based standard procedures and explored the influence of multimorbidity and functional status on bacterial carriage.MethodsSocio-demographic data, vaccination status, multimorbidity, nutrition and functional status defined by Comprehensive Geriatric Assessment were evaluated. We estimated carriage rates with 95% confidence intervals (CI) and explored potential risk factors by logistic regression analysis.ResultsPneumococcal post-serotyping carriage rate was 0.8% (95%CI 0.2–1.9%; 4/526). Serotyping revealed serotypes 4, 7F, 23B and 23F and S. pseudopneumoniae in two other cases. Odds of carriage were higher in men (Odds ratio OR 5.3 (95%CI 0.9–29.4)), in malnourished residents (OR 4.6 (0.8–25.7)), residents living in shared rooms (OR 3.0 (0.5–16.5)) or having contact with schoolchildren (OR 2.0 (0.2–17.6)). The most frequent pathogen was Staphylococcus aureus (prevalence 29.5% (25.6–33.6%)) with meticillin-resistant Staphylococcus aureus prevalence of 1.1%. Gram-negative bacteria (GNB) were found in 22.5% (19.0–26.3%) with a prevalence of extended-spectrum beta lactamase (ESBL) producing bacteria of 0.8%. Odds of S. aureus carriage were higher for immobility (OR 1.84 (1.15–2.93)) and cognitive impairment (OR 1.54 (0.98–2.40)). Odds of GNB carriage were higher in residents with more severe comorbidity (OR 1.13 (1.00–1.28)) and malnutrition (OR 1.54 (0.81–2.91)).ConclusionsGiven the observed data, at least long-term carriage of S. pneumoniae in nursing home residents seems to be rare and rather unlikely to cause nursing home acquired pneumonia. The low rate of colonization with multi drug resistant (MDR) bacteria confirms that nursing home residency is not a risk factor for MDR pneumonia in Germany. For individual risk assessment in this susceptible population, immobility and malnutrition should be considered as signs of functional impairment as well as comorbidity.

Hintergrund: Ziel ist der Vergleich von hochaltrigen Patientinnen mit einer jüngeren Kontrollgruppe nach Deszensuschirurgie hinsichtlich Komorbidität und Komplikationen. Methode: Im Fallkontrolldesign erfolgte die Analyse konsekutiver Daten nach Deszensuschirurgie ab 80. Lebensjahr und einer Kontrollgruppe mittels Clavien-Dindo-(CD-)Klassifikation chirurgischer Komplikationen, Charlson Comorbidity Index und Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistik: Studentʼs t-, Fisherʼs Exactund Mann-Whitney U-Tests. Ergebnisse: Es wurden n = 57 vs. n = 60 Operationen erfasst. Bei Hochaltrigen lag häufiger ein Grad-IV-Prolaps vor (p < 0,001), es erfolgte häufiger eine apikale Fixation (p < 0,001), die OP-Zeiten unterschieden sich nicht. Bei Hochaltrigen fanden sich 21% CD-II + III-Komplikationen, in der Kontrollgruppe 6,6 % (p = 0,031). In beiden Gruppen traten keine CD-IV-und-V-Komplikationen auf, die Verweildauer lag bei 5 (± 1) vs. 4,1 (± 0,8; p < 0,001) Tagen, eine stationäre Weiterbetreuung erfolgte häufiger bei hochaltrigen Patientinnen (p < 0,001). Die Komorbidität Hochaltriger unterschied sich von der Kontrollgruppe in der Anzahl (median 2,0 vs. 1,5; p < 0,001), im CIRS-G (4,1 ± 2,2 vs. 2,4 ± 1,7; p < 0,001) und im Charlson-Index (1,6 ± 1,6 vs. 0,5 ± 0,7; p < 0,001). Schlussfolgerungen: Ein Deszensus kann bei hochaltrigen Patientinnen sicher chirurgisch versorgt werden. Komplikationen erreichten in keinem Fall Intensivtherapiepflichtigkeit oder Lebensbedrohlichkeit, führten aber zu einer verlängerten Verweildauer und häufiger zu geriatrischer oder internistischer stationärer Weiterbehandlung.