Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) infections are frequent and highly impact cancer patients. We developed and validated a scoring system to identify cancer patients harboring ESBL-PE at the National Institute of Cancer of Colombia. Methods: We retrospectively analyzed medical records of 1695 cancer patients. Derivation phase included 710 patients admitted between 2013 to 2015, ESBL-PE positive culture (n = 265) paired by month and hospitalization ward with Non-ESBL-PE (n = 445). A crude and weighted score was developed by conditional logistic regression. The model was evaluated in a Validation cohort (n = 985) with the same eligibility criteria between 2016 to 2017. Results: The score was based on eight variables (reported with Odds Ratio and 95% confidence interval): Hospitalization ≥7 days (5.39 [2.46-11.80]), Hospitalization during the previous year (4, 87 [2.99-7.93]), immunosuppressive therapy during the previous 3 months (2.97 [1.44-6.08]), Neutropenia (1.90 [1.12-3.24]), Exposure to Betalactams during previous month (1.61 [1.06-2.42]), Invasive devices (1.51 [1.012-2.25]), Neoplasia in remission (2.78 [1.25-1.17]), No chemotherapy during the previous 3 months (1.90 [1.22-2.97]). The model demonstrated an acceptable discriminatory capacity in the Derivation phase, but poor in the Validation phase (Recipient Operating Characteristic Curve: 0.68 and 0.55 respectively). Conclusions: Cancer patients have a high prevalence of risk factors for ESBL-PE infection. The scoring system did not adequately discriminate patients with ESBL-PE. In a high-risk population, other strategies should be sought to identify patients at risk of resistant ESBL-PE infection.
BackgroundNew treatments for Hep C are more effective but also increase the cost of treatment and side effects also increase.PurposeTo compare the cost effectiveness of double therapy with interferon plus ribavirin (group 1) with triple therapy including telaprevir or boceprevir (group 2).Material and methodsCross sectional and retrospective study that included patients who started treatment for Hep C since 2014, with genotype 1 and >3 months on treatment. Computerised medical records were reviewed and the outcome of treatment defined as sustained viral response (SVR) or failure; the occurrence of anaemia and neutropenia was recorded. Prescriptions for colony stimulating factors (CSFs) was obtained from the pharmacy program.Results70 patients initiated treatment during the study period: 33/70 (47%) in group 2 (20 used telaprevir).Median duration of treatment in patients who ended treatment (65) was 47 weeks (IQ: 40–47). In 43 patients (66%) a sustained viral response (SVR) was achieved. Group 2 patients responded more than those in group 1: 23/28 (82%) vs. 20/37 (54%) with a relative risk of 1.52 (CI95%: 1.08–2.14). The absolute risk reduction (ARR) of no response was 28% (CI95%: 7–50%) and the number needed to treat (NNT) was 3.56 (CI95%: 2.02–15.01).Mean global cost for group 1, including hematopoietic stimulating factors, was €16,769 ± 5,063 while for group 2 it was 39,849 ± 9,640. These results yielded an incremental cost-effectiveness ratio (ICER) of 82,164 euros (CI95%:46,621–34,430). Haematological toxicity that needed CFSs affected 30/70 patients (43%). This finding was higher in group 2 than in group 1, without statistical significance: 16/28 (57.1%) vs. 14/37 (37%) respectively. Treatment of haematological toxicity added a mean of €2,490 ± 2,494 per course.ConclusionTreatment with triple therapy is more effective than dual but it’s ICER is very high from the payer’s perspective. Given the large socioeconomic impact of Hep C, an approach based on cost-utility analysis would be preferable from a societal perspective.ReferenceWendt A, Bourlire M. An update on the treatment of genotype 1 chronic hepatitis C infection: lessons from recent clinical trials. Ther Adv Infect Dis 2013;1(6):191–208No conflict of interest.
BackgroundCancer patients are susceptible to infections due to immunodeficiency, frequent invasive interventions-devices, chemotherapy and antibiotics exposure. Infections caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae increase morbidity and mortality. The objective was to identify clinical factors associated with ESBL in infected patients with cancer at the Instituto Nacional de Cancerología.MethodsA case–control study was conducted from 2013 to 2015. Cases were infected patients with ESBL-producer Enterobacteriaceae. Controls (matched for date and ward) with non-ESBL-producer Enterobacteriaceae were included. Data were extracted from electronic medical records at index culture: clinical and admission data, Charlson index, immunosuppressive, radio and chemotherapy, neutropenia, invasive devices, surgical procedures and antimicrobial therapy. Microorganisms were identified by the automatized system. Conditional logistic regression and backward stepwise was used to identify predictors of ESBL isolation.ResultsA total of 265 patients with ESBL producer Enterobacteriaceae and 445 non-ESBL producers were identified, mean age 59, 61% male, 48% admitted as outpatients, 73% with solid tumors, 38% with Charlson index ≥4. E.coli and Klebsiella spp. represented 90% of microorganisms. Factor associated with ESBL producer Enterobacteriaceae were hospitalization ≥7 days (OR: 1,59; CI 1.11–2,29), hospitalization the previous year (OR: 4.02; CI 2,68–6,02), immunosuppressive therapy (OR: 2.07; CI 1,05–4.05), Β-lactam therapy the last month (OR: 1.54; CI 1.05–2.26), invasive devices (OR: 1.58; CI 1.10–2.27), active neoplasia (OR: 2,22; CI1.05–4.68), neutropenia (OR: 2.03; CI:1.26–3.27) and absence of chemotherapy during last 3 months (OR: 1.91; CI1.29–2.82). Discriminatory capacity was acceptable (AUC: 0.71).ConclusionThe presence of ESBL-producer Enterobacteriaceae in oncologic patients is associated with health care, hospital admission and length of stay, invasive devices and exposure to antibiotics. The magnitude of associated factors are weak and do not completely allow the identification of cancer patients infected with ESBL-producer Enterobacteriaceae. Disclosures All authors: No reported disclosures.
Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) infections are frequent and highly impact cancer patients. We developed and validated a scoring system to identify cancer patients harboring ESBL-PE at the National Institute of Cancer of Colombia. Methods: We retrospectively analyzed medical records of 1695 cancer patients. Derivation phase included 710 patients admitted between 2013 to 2015, ESBL-PE positive culture (n = 265) paired by month and hospitalization room with Non-ESBL-PE (n = 445). A crude and weighted score was developed by conditional logistic regression. The model was evaluated in a Validation cohort (n = 985) with the same eligibility criteria between 2016 to 2017. Results: The score was based on eight variables (reported with Odds Ratio and 95% confidence interval): Hospitalization ≥7 days (5.39 [2.46 - 11.80]), Hospitalization during the previous year (4 , 87 [2.99 - 7.93]), immunosuppressive therapy during the previous 3 months (2.97 [1.44-6.08]), Neutropenia (1.90 [1.12 - 3.24]), Exposure to Betalactams during previous month (1.61 [1.06 - 2.42]), Invasive devices (1.51 [1.012 - 2.25]), Neoplasia in remission (2.78 [1.25 - 1.17]), No chemotherapy during the previous 3 months (1.90 [1.22 - 2.97]). The model demonstrated an acceptable discriminatory capacity in the Derivation phase, but poor in the Validation phase (Recipient Operating Characteristic Curve: 0.68 and 0.55 respectively). Conclusions: Cancer patients have a high prevalence of risk factors for ESBL-PE infection. The scoring system did not adequately discriminate patients with ESBL-PE. In a high-risk population, other strategies should be sought to identify patients at risk of resistant ESBL-PE infection.
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