Background
Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN.
Methods
A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013–2015) and care bundle (2016–2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary.
Results
A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year.
Conclusion
The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs.
To study the in vitro and in vivo activity of LZD, VAN and its combinations with RIF in a rabbit meningitis model, caused by two strains of S. aureus with different susceptibilities to glycopeptides. Methods In vitro MICs (mg/L): Strain A (LZD = 2, VAN = 1, RIF = 0.018) and B (LZD = 4, VAN = 8, RIF = 512). The bactericidal activity and synergy (time-kill curves) were studied over 24 h. Drugs were tested for a range of concentrations according to their MICs and achievable human serum levels (1/4x-4xMIC) against both strains. In vivo New Zealand rabbits (2.5-3 kg) were used, with an inoculum of 8.5-9 Log cfu/mL. PK/PD parameters (blood and CSF) were determined (Cmax [mg/L]; AUC [mg.h/L]; t1/2 [h]; t > MIC [h]; AUC/MIC) after a single dose of each antimicrobial on infected rabbits. In the therapy experiments, animals (n = 6 per schedule) were grouped in untreated (CON), or treated with LZD (20 mg/kg), VAN (25 mg/kg every 4 hours, 4 doses), RIF (15 mg/kg) every 24 hours (1 dose), LZD+RIF or VAN+RIF. CSF variables analyzed at 0, 4, 6 and 24 h of treatment were: bacterial from Infectious diseases of the nervous system: pathogenesis and worldwide impact Paris, France. 10
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