Abstract:
BACKGROUND:Ventilator-associated pneumonia (VAP) is a common complication of critical illness among surgical and trauma patients. Inappropriate empiric treatment of VAP increases the mortality rate. The rates of Pseudomonas aeruginosa (PA) VAP susceptibility to doripenem (DOR) are higher than those to imipenem-cilastatin (IMI). We developed a model to quantify outcome differences between strategies of empiric treatment of VAP with DOR vs. IMI. METHODS:We designed a cost-effectiveness model comparing empiric treatment of VAP with DOR vs. IMI from both the hospital and societal perspectives. We examined the differences in the number of deaths, hospital length of stay (LOS), total costs, and quality-adjusted life years (QALY) under each scenario and conducted Monte Carlo simulations and sensitivity analyses to determine the stability of our estimates. Drug costs were taken as 80% of wholesale acquisition costs, with other inputs derived from the literature. RESULTS:In the base case analysis, assuming a PA-VAP attributable mortality rate of 38.4% and a 49% relative risk reduction in deaths in PA-sensitive (PA-S) infections to empiric drug compared with a resistant PA (PA-R) organism, DOR use resulted in three additional deaths avoided, 117.4 days of hospitalization averted, and hospital savings of $422,524 per 1,000 patients treated at a cost of $5,748/QALY. All estimates were most sensitive to the costs of treating PA-S and PA-R infections. In a multivariable analysis, hospital cost savings persisted across >80% of the simulations (95% confidence interval $432,615-$2,148,540). CONCLUSIONS:Given the current microbiologic sensitivity profile of PA to DOR and IMI, and depending on the local susceptibility patterns and in institutions where DOR in vitro susceptibilities are superior to those of other carbapenems for PA clinical isolates, empiric treatment of VAP with DOR may dominate that with IMI by being both life- and cost-saving.
journal_name
Surg Infect (Larchmt)journal_title
Surgical infectionsauthors
Zilberberg MD,Mody SH,Chen J,Shorr AFdoi
10.1089/sur.2009.076subject
Has Abstractpub_date
2010-10-01 00:00:00pages
409-17issue
5eissn
1096-2964issn
1557-8674journal_volume
11pub_type
杂志文章abstract:BACKGROUND:Pre-existing humoral barriers challenge the transplantation of living donor kidneys (LDK) into highly sensitized ABO- and human leukocyte antigen (HLA)-incompatible recipients. Conditioning these LDK recipients' immune systems is required before they undergo transplantation. We hypothesized that medical dese...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.231
更新日期:2014-06-01 00:00:00
abstract:PURPOSE:To discover the incidence of postoperative surgical site infections in non-immunocompromised pediatric patients with an absolute neutrophil count (ANC) < or = 1,000 preoperatively. METHODS:Office and hospital charts of consecutive patients with preoperative ANC < or = 1,000 undergoing elective surgery over a t...
journal_title:Surgical infections
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journal_title:Surgical infections
pub_type: 杂志文章
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abstract:: Background: The Gatti and the bilateral internal mammary artery (BIMA) scores were created to predict the risk of deep sternal wound infection (DSWI) after bilateral internal thoracic artery (BITA) grafting. Methods: Both score...
journal_title:Surgical infections
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更新日期:2020-06-01 00:00:00
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abstract:BACKGROUND:Mycobacterium tuberculosis infection rarely penetrates both skull and dura with temporalis muscle abscess formation. METHODS:Case report and review of the literature. RESULTS:A non-immunocompromised female patient with a right temporal mass underwent surgical resection. The tubercular abscess extended from...
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journal_title:Surgical infections
pub_type: 杂志文章,评审
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更新日期:2010-08-01 00:00:00
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journal_title:Surgical infections
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更新日期:2011-10-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.135
更新日期:2014-06-01 00:00:00
abstract:: Background: Post-operative central nervous system infections (PCNSIs) caused by extensively drug-resistant (XDR) or pan-drug-resistant (PDR) Acinetobacter baumannii are rare but intractable problems. To investigate a potential combined strategy to treat Acinetobacter bauma...
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更新日期:2020-12-01 00:00:00
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更新日期:2013-02-01 00:00:00
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更新日期:2010-08-01 00:00:00
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journal_title:Surgical infections
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更新日期:2017-02-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章,评审
doi:10.1089/sur.2005.6.233
更新日期:2005-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2020-02-01 00:00:00
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pub_type: 杂志文章
doi:10.1089/sur.2015.150
更新日期:2016-10-01 00:00:00
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journal_title:Surgical infections
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更新日期:2011-10-01 00:00:00
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更新日期:2000-10-01 00:00:00
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journal_title:Surgical infections
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更新日期:2015-10-01 00:00:00
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更新日期:2003-07-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2016-10-01 00:00:00
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更新日期:2020-05-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2006.7.527
更新日期:2006-12-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章
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更新日期:2020-05-29 00:00:00
abstract:BACKGROUND:The pathophysiologic features of acute respiratory distress syndrome (ARDS) are attributed to neutrophil accumulation and over-activation. Low blood immunoglobulin G concentrations in septic shock patients are associated with higher risk of developing ARDS. This study showed the effects of intravenous immuno...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.227
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:The incidence and consequences of post-operative infections in patients undergoing major elective surgery is not well understood. METHODS:Using a large U.S. healthcare claims database, we identified all patients who underwent major elective surgery between January 1, 2007, and December 31, 2009. For each su...
journal_title:Surgical infections
pub_type: 杂志文章
doi:10.1089/sur.2012.200
更新日期:2014-06-01 00:00:00
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journal_title:Surgical infections
pub_type: 杂志文章,评审
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