Ni escmid-esgni-kayseri 2015

Prof. Dr. Ata Nevzat Yalçın, MDProf. Dr. Ata Nevzat Yalçın, MDAkdeniz University, Medicine FacultyAkdeniz University, Medicine Faculty

Dept. Infectious Dis. and Clinical MicrobiologyDept. Infectious Dis. and Clinical MicrobiologyAntalya-TURKEYAntalya-TURKEY

Economical analysis of nosocomial infections:

How can we do it?

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• NosocomialNosocomial infections ( infections (NNI) represent an I) represent an important public health problem in important public health problem in developing countries as in developed developing countries as in developed ones today as a major cause of high ones today as a major cause of high morbidity, mortality and economic morbidity, mortality and economic consequences in hospitalized patients.consequences in hospitalized patients.

Nosocomial infectionsNosocomial infections

Jarvis WR. Jarvis WR. Infect Control Hosp EpidemiolInfect Control Hosp Epidemiol 1996;17: 552-7 1996;17: 552-7

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Importance of Nosocomial Importance of Nosocomial infectionsinfections

The burden of Nosocomial infectionsThe burden of Nosocomial infections ( (NIs) is NIs) is substantial in developed countries, where it affects substantial in developed countries, where it affects from 5% to 15% of hospitalized patients in regular from 5% to 15% of hospitalized patients in regular wards, and as many as 50% or more of patients in wards, and as many as 50% or more of patients in intensive care units (ICUs).intensive care units (ICUs).

The incidence of NIs is between 25% and 40% in The incidence of NIs is between 25% and 40% in developing countries.developing countries.

NIsNIs increase length of stay in hospital.increase length of stay in hospital. NIsNIs increase costs.increase costs. NIsNIs increase mortality.increase mortality.

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Points of This TalkPoints of This Talk

Incidence of NI and costIncidence of NI and cost Pharmacoeconomical analysisPharmacoeconomical analysis Excess costExcess cost Excess cost in NIExcess cost in NI Cost of antibioticsCost of antibiotics Extra length of stay Extra length of stay Extra mortalityExtra mortality

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Nosocomial infectionsNosocomial infections

Germany Germany → → 525.000-800.000 cases525.000-800.000 cases

~ 20.000- 40.000 deaths~ 20.000- 40.000 deaths UKUK → → 500.000-1.000.000 cases500.000-1.000.000 cases

~ 5.000 deaths~ 5.000 deaths USAUSA → → 2.220.000 cases2.220.000 cases

~ 115.000 deaths~ 115.000 deaths EUEU → → 4.500.000 cases4.500.000 cases

~ 111.000 deaths~ 111.000 deaths

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Excess Cost of Nosocomial Excess Cost of Nosocomial InfectionsInfections

NorwayNorway → → → → 132 Million Dollars132 Million Dollars Scotland Scotland → → → → 168 Million Pounds168 Million Pounds EnglandEngland → → → → 1,7 Billion Dollars1,7 Billion Dollars FranceFrance → → → → 3-5 Billion Franks3-5 Billion Franks USAUSA → → → → 37-45 Billion Dollars37-45 Billion Dollars EUEU → → → → 7 Billion Euros7 Billion Euros TurkeyTurkey → → → → 1-1,5 Billion Dollars ???1-1,5 Billion Dollars ??? Andersen BM, et al. Andersen BM, et al. Infect Control Hosp Epidemiol Infect Control Hosp Epidemiol 1998;19: 805-71998;19: 805-7

Astagneau P, et al. Astagneau P, et al. J Hosp InfectJ Hosp Infect 1999; 42 : 303-12 1999; 42 : 303-12Plowman R, et al. Plowman R, et al. J Hosp InfectJ Hosp Infect 2001;47: 198-207 2001;47: 198-207

Graves N. Graves N. Emerg Infect DisEmerg Infect Dis 2004;10: 561-6 2004;10: 561-6ECDC Annual Report 2008: 16-38ECDC Annual Report 2008: 16-38

Dickema DJ, et al. Dickema DJ, et al. JAMAJAMA 2008;299:1190-2 2008;299:1190-2Hassan M, et al. Hassan M, et al. Hospital TopicsHospital Topics 2010;88:82-9 2010;88:82-9

Zimlichman E, et al. Zimlichman E, et al. JAMAJAMA Intern MedIntern Med 2013 2013 Marchetti A. et al.Marchetti A. et al. J Med Economics J Med Economics 2013:1-6 2013:1-6

Magill SS, et al. Magill SS, et al. NEJMNEJM,2014;370:1198-1208,2014;370:1198-1208

Zimlichman E, et al. Zimlichman E, et al. JAMA Intern MedJAMA Intern Med 2013; 173:2039-46 2013; 173:2039-46

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• Pneumonias → → 35,967Pneumonias → → 35,967• Bloodstream inf. → → 30,655Bloodstream inf. → → 30,655• Urinary tract inf. → → 8,225Urinary tract inf. → → 8,225• Surgical site inf. → →13,088Surgical site inf. → →13,088• Others → →12,085Others → →12,085• TOTAL → →100,000TOTAL → →100,000

Nosocomial Infections and Nosocomial Infections and mortality mortality

(US Department of Health and Human Services (DHHS-2009)(US Department of Health and Human Services (DHHS-2009)

Stone PW. Stone PW. Expert Rev Pharmacoecon Outcomes ResExpert Rev Pharmacoecon Outcomes Res 2009;9:417-22 2009;9:417-22

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Calculating costsCalculating costs(Methodological subjects-1)(Methodological subjects-1)

Study designStudy design Patient group (incidence,prevalence,epidemics)Patient group (incidence,prevalence,epidemics) Location (hospital, follow-up after discharge)Location (hospital, follow-up after discharge) Dimension of the study (hospital, country, Dimension of the study (hospital, country,

developing countries, pathogens, interventions)developing countries, pathogens, interventions)

Wilcox MH, et al. Wilcox MH, et al. J Hosp InfectJ Hosp Infect 2000;45:81-4 2000;45:81-4

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Calculating costsCalculating costs(Methodological subjects-2)(Methodological subjects-2)

Extra cost and design of length of stayExtra cost and design of length of stay Costs (hospital charges, deaths, antibiotics Costs (hospital charges, deaths, antibiotics

utilisation, antibiotic resistance, environmental utilisation, antibiotic resistance, environmental damage)damage)

Conclusion statistics (mean, median, percent, total)Conclusion statistics (mean, median, percent, total) Design of analysisDesign of analysis


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Costs

1. Well described costs associated with nosocomial infections

2. Poorly described costs associated with nosocomial infections

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Well described costs Well described costs associated with NIassociated with NI

Drug (antibiotics) acquisitionDrug (antibiotics) acquisition

Increased hospital stayIncreased hospital stay


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Poorly described costs associated Poorly described costs associated with NIwith NI

Control measures (isolation facilities, Control measures (isolation facilities, commitees, policies)commitees, policies)

Impaired hospital activity (ward closing, etc.)Impaired hospital activity (ward closing, etc.) Confidence, performance of staffConfidence, performance of staff LitigationLitigation Effects on communityEffects on community MorbidityMorbidity MortalityMortality


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Excess costs of NI Excess costs of NI (Adults)-(US Dollars)(Adults)-(US Dollars)

Study Year Country Cost ($$))

Westwood JCN 1974 USA 1,650

Haley RW 1980 USA 1,018

Coello R 1993 England 1,759

Diaz Molina C 1993 Spain 1,909

Yalcin AN 1997 Turkey 1,582

Orrett FA 1998 Trinidad 1,910

Andersen BM 1998 Norway 2,200

Chen YY 2003 Taiwan 3,306

Roberts 2010 USA 1,581-6,824

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Excess costs of NI Excess costs of NI (Pediatrics)-(US Dollars)(Pediatrics)-(US Dollars)

Study Year Country Cost ($$))

Leroyer A 1997 France 10,440

Navarette D 1999 Mexico 11,682

Mahieu LM 2001 Belgium 12,399

Yalcin AN. Yalcin AN. Indian J Med SciIndian J Med Sci 2003;57:450-6 2003;57:450-6

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Studies on excess costs in Studies on excess costs in nosocomial infectionsnosocomial infections

Surgical site infectionsSurgical site infections Bloodstream infectionsBloodstream infections Catheter-related bloodstream infectionsCatheter-related bloodstream infections PneumoniasPneumonias Ventilator-associated pneumoniasVentilator-associated pneumonias

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Surgical site infections

Songklanagarind Hospital, Chiang Mai University, Thailand,1998-2003

140 matched pairs of case and control Procedures:Appendectomy, herniorrhaphy,

mastectomy, cholecystectomy, colostomy and craniotomy

Mean extra hospital charge………43,658 Baht (95 % C.l;30,228-57,088 Baht ) (p(p<< 0.001) 0.001)

Mean excess postoperative stay…..21,3 days (95 % C.l;16,6-26,0 days) (p(p<< 0.001) 0.001)

Kasatpibal N, et al. Kasatpibal N, et al. J Med Assoc ThaiJ Med Assoc Thai 2005;88:1083-91 2005;88:1083-91

Surgical site infections (1)

Plymouth, England, April 2010-March 2012,

282 operations Additional length of stay….10 days (7-13

days) Extra cost…5 239 Pounds (4622-6719) Total cost…..2 491 424 Pounds

Jenks PR, et al. Jenks PR, et al. J Hosp Infect J Hosp Infect 2014;86:24-33 2014;86:24-33

Jenks PR, et al. Jenks PR, et al. J Hosp Infect J Hosp Infect 2014;86:24-33 2014;86:24-33


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Nosocomial bloodstream Nosocomial bloodstream infections (ICU)infections (ICU)

Dr BL Kapur Memorial Hospital, New Delhi, India, 2006 24 patients and 48 controls Excess hospitalization: 11,6 days Excess hospitalization: 11,6 days (p(p<< 0.0001) 0.0001)

Mortality : 54 % Mortality : 54 % (p(p<< 0.0001) 0.0001)

Excess cost: Excess cost: $$14,818 (10,663 -18,974), (14,818 (10,663 -18,974), (pp<< 0.0001) 0.0001)

Kothari A, et al. Kothari A, et al. J Hosp InfectJ Hosp Infect 2009;71:143-8 2009;71:143-8

Nosocomial bloodstream Nosocomial bloodstream infections in elderlyinfections in elderly

Cases (n:830) Controls

(n:830)

Mortality 49.4 % 33.2 %(p(p<< 0.001) 0.001)

Excess length of stay

29.2 days 20.2 days (p(p<< 0.001) 0.001)

Cost $ 102.276 $ 69.690 (p(p<< 0.001) 0.001)

Kaye KS, et al. J Am Geriatr Soc 2014 ; 62 : 306-11

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Central catheter-related Central catheter-related bloodstream infectionsbloodstream infections

Six ICU, Buenos Aires, Argentina, 1997-2002Six ICU, Buenos Aires, Argentina, 1997-2002 142 patients, 142 controls142 patients, 142 controls Excess hospitalization: 11,9 days Excess hospitalization: 11,9 days Excess mortality: 24,6 %Excess mortality: 24,6 % Excess cost: Excess cost: $$4,8884,888 Excess antibiotics cost: Excess antibiotics cost: $$1,9131,913

Rosenthal VD, et al. Rosenthal VD, et al. Am J Infect ControlAm J Infect Control 2003;31:475-80 2003;31:475-80

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Central venous catheter-associated Central venous catheter-associated

bloodstream infections (ICU)bloodstream infections (ICU) General Hospital, Specialties Intituto Mexicano del General Hospital, Specialties Intituto Mexicano del Seguro Social Hospital, Gabriel Mancera Hospital, Seguro Social Hospital, Gabriel Mancera Hospital, Mexico City, Mexico, 2002-3Mexico City, Mexico, 2002-3

55 patients, 55 controls55 patients, 55 controls Excess hospitalization: 6,1 days Excess hospitalization: 6,1 days Excess mortality: 20%Excess mortality: 20% Excess cost (mean): Excess cost (mean): $$11,59111,591 Excess antibiotics cost (mean): Excess antibiotics cost (mean): $$598598

Higuera F, et al. Higuera F, et al. Infect Control Hosp EpidemiolInfect Control Hosp Epidemiol 2007;28:31-5 2007;28:31-5

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Nosocomial pneumoniasNosocomial pneumonias

Six ICU, Buenos Aires, Argentina, 2001-2005Six ICU, Buenos Aires, Argentina, 2001-2005 307 n. pneumonias, 307 controls307 n. pneumonias, 307 controls Excess cost → $ 2,255Excess cost → $ 2,255 Excess antibiotic cost → $ 996 Excess antibiotic cost → $ 996 Extra length of stay → 8,95 daysExtra length of stay → 8,95 days Extra mortality → 30,3 %Extra mortality → 30,3 %

Rosenthal D, et al. Am J Rosenthal D, et al. Am J Infect Control Infect Control 2005;33:157-612005;33:157-61

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StudyStudy

(period)(period)CountryCountry NumberNumber

VAP/VAP/

ControlControl

CostCost

VAPVAP

(($$))

CostCost

Control Control (($$))

pp

Hugonnet SHugonnet S

(1995-1997)(1995-1997)

SwitzerlandSwitzerland 97/9797/97 24 72724 727 17 43817 438 ‹ ‹ 0.0010.001

Warren DKWarren DK

(1998-1999)(1998-1999)

USAUSA 127/692127/692 70 56870 568 21 62021 620 ‹ ‹ 0.0010.001

Cocanour CSCocanour CS

(2002-2003)(2002-2003)

USAUSA 70/7070/70 82 19582 195 25 03725 037 ‹ ‹ 0.050.05

Karaoğlan HKaraoğlan H

(2004-2005)(2004-2005)

TurkeyTurkey

(Antalya)(Antalya)

81/8181/81 8 6028 602 2 6212 621 ‹ ‹ 0.00010.0001

Kollef MAKollef MA

(2008-2009)(2008-2009)

USA 2144/2144 133 371 74 729 ‹ ‹ 0.00010.0001

Ventilator-associated pneumonias

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HA-Cl.difficile infections

Retrospective, cohort studyRetrospective, cohort study New York State, 2007-8New York State, 2007-8 4 853 000 HA-CDI cases4 853 000 HA-CDI cases 29 000 deaths (USA)29 000 deaths (USA) Average cost per patient…$ 29 000Average cost per patient…$ 29 000 Annual cost……$55 millionAnnual cost……$55 million

Lipp MJLipp MJ, et al. , et al. J Gastroenterol Hepatol J Gastroenterol Hepatol 20201212;;2727:: 1733-7 1733-7

Resistant microorganisms and cost

Vienna, Austria, January-June 2002

Daxboeck F, et al. J Hosp Infect 2006; 614-8

MDRMDR-GNB -GNB

(s: 99)(s: 99)

MRSA MRSA

(s: 74)(s: 74)

pp

Length of Length of staystay

42 gün42 gün 37 gün37 gün 0.20.2

CostCost 18 115 18 115 ££ (582- (582- 149 817)149 817)

6 624 6 624 ££ (516- (516- 108 558)108 558)

0.010.01

A.baumannii -BSI

Taipei,Taiwan, April 1996- August 2001

Lee NY, et al. Infect Control Hosp Epidemiol 2007;28:713-9

ResistantResistant--A.baumannii A.baumannii

((nn: 46): 46)

Sensitive Sensitive A.baumannii A.baumannii

((nn: 46): 46)

pp

Length of Length of staystay

54.2 54.2 daysdays 34.1 34.1 daysdays 0.0060.006

CostCost $ $ 9 3499 349 $ $ 4 8654 865 0.0010.001

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StudyStudy YearYear NumberNumber

ResRes//

Suscept.Suscept.

ResistantResistant

(($$))

SusceptibleSusceptible (($$))

pp

GasinkGasink

(Quinolone)(Quinolone)

20062006 320/527320/527 62 32562 325 48 73348 733 0.000.0088

EvansEvans

(Imipenem)(Imipenem)

20072007 47/7347/73 99 67299 672 69 50269 502 0.00.01515

Eagye Eagye

(Meropenm)(Meropenm)

20092009 58/11558/115 100 700100 700 32 59432 594 ‹ ‹ 0.00.00101

LautenbachLautenbach

(Imipenem)(Imipenem)

20102010 2289/2532289/253 286 417286 417 189 274189 274 ‹ ‹ 0.0010.001

Morales Morales

(MDR)(MDR)

2012 134/149 13 178 4 258 ‹ ‹ 0.0010.001

Cost: P.aeruginosa

Nathwani DNathwani D. . Antimicrob Resistance Antimicrob Resistance Infect Control Infect Control 2014;3:32-482014;3:32-48

Impact of antimicrobial resistance on cost

Microorganism Attributable cost

CR-Non-fermenters $ 58 457 - 85 299

MDR A.baumannii $ 4484

ESBL(+) Enterobacteriaceae

$ 1584 - 30 093

MRSA $ 1014 - 40 090

Giannoula S, et al. Giannoula S, et al. Expert Rev AntiExpert Rev Anti Infect Ther Infect Ther 20120133;;1111::321-31321-31

Impact of antimicrobial resistance on cost

Microorganism Excess cost

VRE $ 16 711 – 60 988

MDR A.baumannii $ 5336 – 126 856

ESBL(+) Enterobacteriaceae

$ 3658 - 4892

MRSA $ 695 – 29 030

Gandra S, et al. Gandra S, et al. Clin Microbiol Infect Clin Microbiol Infect 20120144;;2020::973-9973-9

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Costs of NI-USA Costs of NI-USA (US (US $$))

Infection type Costs

(Mean)

Range

(Minimum-maximum)

CLA-Bloodstream infections

$ 45,814 30,919-65,245


$ 40,144 36,286-44,220


$ 20,785 18,902-22,667

Urinary tract infections

$ 896 603-1,189

Zimlichman E, et al. Zimlichman E, et al. JAMA Intern MedJAMA Intern Med 2013; 173:2039-46 2013; 173:2039-46

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Attributable costs of NI (US Attributable costs of NI (US $$))

Infection type Attributable costs

(Mean)

Range

(Minimum-maximum)


22,875 9,986-54,503

CLA-Bloodstream infections

18,432 3,592-34,410


17,944 7,874-26,668

Urinary tract infections

1,257 804-1,710

Yokoe DS, et al. Yokoe DS, et al. Infect Control Hosp EpidemiolInfect Control Hosp Epidemiol 2008; 29 (Suppl. 1):S3-S11 2008; 29 (Suppl. 1):S3-S11

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Costs of Nosocomial infectionsCosts of Nosocomial infections

HAIHAI ControlControl

BedBed 464 464 214 214 LaboratoryLaboratory 417 417 249 249 AntibioticsAntibiotics 1190 1190 54 54 OthersOthers 209 209 181 181 TOTAL TOTAL $ 2280 $ 698 $ 2280 $ 698

Yalcin AN, et al. Yalcin AN, et al. J ChemotherJ Chemother 1997; 9:411-4 1997; 9:411-4

(Hacettepe University Hospital, Ankara, Turkey, 1995)(Hacettepe University Hospital, Ankara, Turkey, 1995)

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Distribution of costs in Distribution of costs in Nosocomial infectionsNosocomial infections

Yalcin AN, et al. Yalcin AN, et al. J Chemother J Chemother 1997; 9: 411- 4 1997; 9: 411- 4

(Hacettepe University Hospital, Ankara, Turkey, 1995)(Hacettepe University Hospital, Ankara, Turkey, 1995)

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Distribution of cost (VAP)($)

Costs Costs of VAP Group ± SD (min-

max)

Costs of Control Group ± SD (min-

max)

P value

Bed 1193.7±679.8 (176-3140) 381.0±382.2 (154-3320) <0.0001

Antibiotics 837.1±472.9 (40-2140) 8.5±11.0 (0-40) <0.0001

Drugs and medical materials

2305.0±1347.6 (330-8143)

816.7±645.9 (125-4125) <0.0001

Laboratory 1647.0±1004.5 (248-8068)

546.4±442.4 (34-2335) <0.0001

Radiology 269.9±222.1 (36-1683) 156.8±160.9 (16-806) <0.0001

Operation 628.2±1190.1 (0-7280) 302.4±535.3 (0-2523) <0.05

Intervention 1024.6±973.8 (135-7794) 254.3±271.7 (43-1579) <0.0001

Care 696.7±613.1 (72-3753) 155.4±192.8 (23-1524) <0.0001

Total 8602.7±5045.5 2621.9±2053.3 <0.0001

Karaoğlan H,Yalcin AN, et al. Karaoğlan H,Yalcin AN, et al. Infez Med Infez Med 2010;18:248-552010;18:248-55

(Akdeniz University Hospital, Antalya, Turkey, 2006-7)(Akdeniz University Hospital, Antalya, Turkey, 2006-7)

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Daily antibiotic cost in Daily antibiotic cost in nosocomial infectionsnosocomial infections

Urinary tract infectionsUrinary tract infections 96-203 FF 96-203 FF PnemoniasPnemonias 108-219 FF108-219 FF Surgical site infectionsSurgical site infections 116-220 FF116-220 FF Bloodstream infectionsBloodstream infections 165-287 FF165-287 FF

Astagneau P, et al. Astagneau P, et al. J Hosp Infect J Hosp Infect 1999;42:303-12 1999;42:303-12

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Daily antibiotic cost in nosocomial Daily antibiotic cost in nosocomial infectionsinfections

Yalçın AN, et al. Yalçın AN, et al. Turk J Hosp Inf Turk J Hosp Inf 2002;6:41-5 2002;6:41-5

(Pamukkale University Hospital, Denizli, Turkey, 2001)(Pamukkale University Hospital, Denizli, Turkey, 2001)

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Daily antibiotic cost in Daily antibiotic cost in nosocomial infectionsnosocomial infections

MS-KNSMS-KNS $ 44,9 $ 44,9 MSMS-S.aureus-S.aureus $$ 46,7 46,7 E.coliE.coli $ 48,5 $ 48,5 EnterobacterEnterobacter spp. spp. $ 63,8 $ 63,8 MR-MR-S.aureusS.aureus $ 80,0 $ 80,0 P.aeruginosaP.aeruginosa $ 111,7 $ 111,7

Yalçın AN, et al. Yalçın AN, et al. Turk J Hosp Inf Turk J Hosp Inf 2002;6: 41-5 2002;6: 41-5

(Pamukkale University Hospital, Denizli, Turkey, 2001)(Pamukkale University Hospital, Denizli, Turkey, 2001)

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Daily antibiotic cost in nosocomial Daily antibiotic cost in nosocomial infections infections

Inan D, et al. Inan D, et al. BMC Infect Dis BMC Infect Dis 2005; 5 :1-5 2005; 5 :1-5

(Akdeniz University Hospital, Antalya, Turkey, 2004)(Akdeniz University Hospital, Antalya, Turkey, 2004)

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Costs of NIs with gram Costs of NIs with gram negativenegative non-fermentative rodsnon-fermentative rods

Aşık Z,Yalçın AN et al. (Aşık Z,Yalçın AN et al. (Thesis-2011-Akdeniz UniversityThesis-2011-Akdeniz University))

(Akdeniz University Hospital, Antalya, Turkey, 2011)(Akdeniz University Hospital, Antalya, Turkey, 2011)

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Excess length of stay in Excess length of stay in nosocomial infectionsnosocomial infections

Study Year Country LOS (days)

Westwood JCN 1974 USA 22,0

Haley RW 1980 USA 13,4

French GL 1991 Hong Kong 23,4


Orrett FA 1998 Trinidad 33,5

Sanou J 1999 Burkina Faso 10,0

Roberts R 2010 USA 5,9-9,6

Askarian M 2003 Iran 6,2

Sanchez-V LD 2006 Mexico 10,0

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Excess length of stay in nosocomial Excess length of stay in nosocomial infectionsinfections

Infection type Excess length of stay (days)

Urinary tract infection 1-4

Surgical site infection 7-8,2

Bloodstream infection 7-21

Pneumonias 6,8-30

Jarvis WR. Jarvis WR. Infect Control Hosp EpidemiolInfect Control Hosp Epidemiol 1996;17: 552-7 1996;17: 552-7

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Excess length of stay in NIExcess length of stay in NI (days)(days)

UTIUTI VAPVAP CR-BSICR-BSI

ArgentinaArgentina 7.97.9 8.78.7 9.39.3

BrasilBrasil 8.98.9 9.19.1 7.87.8

MexicoMexico 5.95.9 10.710.7 7.17.1

TurkeyTurkey 8.78.7 8.38.3 9.59.5

IndiaIndia 4.24.2 5.45.4 2.02.0

INICC Project (ICAAC-2005) posters :K-1916, K-1920, K-1922, K-1923, K-1924INICC Project (ICAAC-2005) posters :K-1916, K-1920, K-1922, K-1923, K-1924

Extra mortality in nosocomial Extra mortality in nosocomial infections (%)infections (%)

Study Year Country Mortality rate

Spengler RF 1978 USA 32,1

French GL 1991 Hong Kong 7,4

Dinkel RH 1994 USA 4,1


Martin M 2001 Spain 21,3

Roberts 2010 USA 6,1

Mortality:Resistant and susceptible P.aeruginosa

46Nathwani DNathwani D. . Antimicrob Resistance Antimicrob Resistance Infect Control Infect Control 2014;3:32-482014;3:32-48

Methodological limitations in studies assessing disease burden

attributable to ARI

Failure to adjust for hospital stay prior to onset of infection

Failure to adjust for severity of underlying illness and comorbidities

Failure to adjust for effective antibiotic therapy

Failure to consider exposure as time-dependent


Reasons for variability in outcomes of antibiotic-resistant

infections Heterogeneity in study population Inadequate sample size Type of control group Causative pathogens Location of infection site Definitions of resistance Follow-up time


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Economical analysis studies in NIsEconomical analysis studies in NIs

Use of guidelines for authors and editors on Use of guidelines for authors and editors on conducting an economic analysis,conducting an economic analysis,

Continued development of more sophisticated Continued development of more sophisticated mathematical models,mathematical models,

Training of infection control professionals in Training of infection control professionals in economic methods ……economic methods ……

Stone PW, et al. Stone PW, et al. Am J Infect ControlAm J Infect Control 2005; 33:501-9 2005; 33:501-9

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Thanks……..

[email protected] [email protected]

Ni escmid-esgni-kayseri 2015

Health & Medicine

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