Escherichia coli is the leading cause of bloodstream infections (BSIs) caused by Gram-negative bacteria. The increasing prevalence of antibiotic-resistant E. coli strains, particularly those producing extendedspectrum ␤-lactamases (ESBLs), increases the odds that empirically prescribed antimicrobial therapy for these infections will be inadequate, but the economic impact of this risk has not been fully evaluated. In the present retrospective 1-year analysis of 134 consecutive E. coli BSIs in our hospital, we explored the clinical and economic impacts of (i) inadequate initial antimicrobial treatment (IIAT) (i.e., empirical treatment with drugs to which the isolate had displayed in vitro resistance) of these infections and (ii) ESBL production by the bloodstream isolate. Cost data were obtained from the hospital accounting system. Compared with the 107 (79.8%) adequately treated patients, the 27 (20.1%) who received IIAT had a higher proportion of ESBL BSIs (74.0% versus 15.8%), longer (؉6 days) and more costly (؉EUR 4,322.00) post-BSI-onset hospital stays, and higher 21-day mortality rates (40.7% versus 5.6%). Compared with the 97 non-ESBL infections, the 37 (27.6%) ESBL BSIs were also associated with longer (؉7 days) and more costly (؉EUR 5,026.00) post-BSI-onset hospital stays and increased 21-day mortality (29.7% versus 6.1%). These findings confirm that the hospital costs and mortality associated with E. coli BSIs are significantly increased by ESBL production and by IIAT.Escherichia coli is the leading cause of bloodstream infections (BSIs) involving Gram-negative bacteria (16, 37). The last 20 years have witnessed a striking increase in the number of infections caused by antibiotic-resistant strains of E. coli, and this has had an important impact on the outcomes of BSIs (24). Multidrug-resistant (MDR) E. coli strains and particularly those that produce extended-spectrum ␤-lactamases (ESBL) not only are endemic in many health care settings but also have become an important cause of communityacquired infections (1,27,28). These organisms are resistant to many of the antimicrobial agents usually recommended for the treatment of infections caused by E coli, so the odds are quite high that empirically prescribed antimicrobial therapy will be ineffective against these infections (4,9,18,22,23,25,26, 29,32,35).Our previous studies showed that failure to provide prompt, effective antimicrobial therapy for BSIs caused by ESBL-producing E. coli is associated with increased mortality and longer hospital stays (35, 36). Similar findings have been reported by others (15,18,20,24,31,32). Length of stay (LOS) has been identified as the single most important determinant of costs related to inpatient care for bacteremia (3). Inadequate initial antimicrobial therapy (IIAT) has been shown to increase hospitalization costs related to intra-abdominal and other sterilesite infections caused by methicillin-resistant Staphylococcus aureus (33), but this issue has not been specifically explored with reference to BSIs caused by E....

HS is a safe alternative to KT, allowing for a significant reduction of operative time without increasing complications rate and overall costs and probably better utilization of health resources.

Guiding principles for good practices set up a benchmark for HB-HTA because they represent the ideal performance of HB-HTA units; nevertheless, when performing HTA at hospital level, context also matters; therefore, they should be adapted to ensure their applicability in the local context.

Objectives:The aim of this study was to analyze and describe process and outcomes of two pilot assessments based on the HTA Core Model, discuss the applicability of the model, and explore areas of development. Methods: Data were gathered from HTA Core Model and pilot Core HTA documents, their validation feedback, questionnaires to investigators, meeting minutes, emails, and discussions in the coordinating team meetings in the Finnish Office for Health Technology Assessment (FINOHTA). Results: The elementary structure of the HTA Core Model proved useful in preparing HTAs. Clear scoping and good coordination in timing and distribution of work would probably help improve applicability and avoid duplication of work. Conclusions: The HTA Core Model can be developed into a platform that enables and encourages true HTA collaboration in terms of distribution of work and maximum utilization of a common pool of structured HTA information for national HTA reports.

Objectives:The aim of this study was to review the history of health technology assessment (HTA) in Italy. Methods: Founded in 1978, the Italian National Health Service (NHS) has been strongly regionalized mainly after a constitutional reform, which started a devolution process. HTA started in the 1980s at the National Institute of Health and in a few University Hospitals, with a focus on big ticket technology: that process was driven by clinical engineers. Results: In recent years, HTA is becoming an important tool for decision-making processes at central, regional, and local levels. In particular, the National Agency for Regional Health Services (AGENAS) and five regions (of twenty-one) are strongly committed to develop HTA initiatives connected with the planning process. Conclusions: At the local level, the hospital-based HTA activity is probably the most important peculiarity of the country and the real driver of the HTA movement.