Antibiotic Costs Research Articles

General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study.

To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany). Verbatim transcripts were analysed through inductive qualitative content analysis. We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation and shared decision making were seen as helpful in this process. We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.

Injectable antibiotic use in India: public-private share in volume and cost.

Consumption of injectable antibiotics is not widely studied, despite injectables constitute a major share of antibiotic cost. This study aimed to understand the share of oral and injectable antibiotic consumption and cost at the national level in India, and the public and private sector shares in the provision and cost of injectables in Kerala state. We used the PharmaTrac private sector sales dataset and the Kerala Medical Services Corporation public sector procurement dataset. Using WHO Access, Watch, Reserve (AWaRe) and Anatomical Therapeutic Chemical (ATC) Classifications, we estimated the annual total and per-capita consumption, and the annual total, per defined daily dose (DDD), and per-capita spending on injectables. Although 94.9% of total antibiotics consumed at the national level were oral preparations, 35.8% of total spending were on injectables. In Kerala , around 33% of total antibiotic spending in the private sector were for injectables, compared to around 25% in the public sector. The public sector used fewer injectable antibiotic formulations (n=21) compared the private sector (n=69). The cost per DDD was significantly higher in the private sector as compared to the public sector. Despite only accounting for 6.3% of the cost share, the public sector provided 31.4% of injectables, indicating very high efficiency. Across both sectors, Watch group antibiotics were significantly more consumed and at a significantly higher cost than Access group antibiotics, for example in nearly double the quantity and at 1.75 times the price per DDD in the private sector. Reserve group antibiotics made up the lowest consumption share (0.61% in the private sector), but at the highest cost per DDD (over 16 times that of Access). Public sector showed higher cost efficiency in antibiotic provisioning compared to private sector. Appropriate antibiotic use cannot be achieved through drug price control alone but requires extensive engagement with private providers through structured stewardship programs.

Clinical and Economic Burden of Antibiotic Use Among Pediatric Patients With Varicella Infection in the Outpatient Setting: A Retrospective Cohort Analysis of Real-world Data in France.

Varicella infects 90% of children before age 9. Though varicella is self-limiting, its complications may require antibiotics, though how antibiotics are utilized for varicella in France is not well known. This study assessed antibiotic use and costs associated with varicella and its complications in pediatric patients managed in the outpatient setting in France. A retrospective cohort study using the Cegedim Strategic Data-Longitudinal Patient Database, an electronic medical record database from general practitioners and office-based specialists in France, was conducted. Children <18 years old diagnosed with varicella between January 2014 and December 2018 with 3-month follow-up available were included. We used descriptive analysis to assess varicella-related complications, medication use, healthcare resource utilization and costs. Overall, 48,027 patients were diagnosed with varicella; 15.3% (n = 7369) had ≥1 varicella-related complication. Antibiotics were prescribed in up to 25.1% (n = 12,045/48,027) of cases with greater use in patients with complications (68.1%, n = 5018/7369) compared with those without (17.3%, n = 7027/40,658). Mean medication and outpatient varicella-related costs were €32.82 per patient with medications costing a mean of €5.84 per patient; antibiotics contributed ~23% to total costs annually. This study showed high antibiotic use for the management of varicella and its complications. A universal varicella vaccination program could be considered to alleviate complications and associated costs in France.

Evaluation of costs related to antimicrobial resistance of priority Gram-negative bacilli

Introduction. Antimicrobial Resistance (AMR) is one of the most serious threats to global public health, causing over 700 thousand deaths annually. In addition to the social burden, AMR generates high medical costs, and estimating these at the hospital level has been the subject of research in many international studies. &#x0D; Material and methods. A comprehensive study was conducted, encompassing 172 cases of invasive infections recorded in patients hospitalized at the “Timofei Mosneaga” Republican Clinical Hospital, from which strains of antimicrobial-resistant E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa were isolated in the years 2019-2021. Based on data regarding the duration of hospitalization, treatment costs, and expenses for investigations, indicators such as average cost, the median, minimum and maximum values of treatment, including the cost of antibiotics and laboratory analyses, were calculated.&#x0D; Results. The economic impact indicators of AMR at the hospital level include: the duration of hospitalization, the total costs of a treated case, the costs of antibiotics, and the costs of laboratory analyses. In the structure of microorganisms isolated from the patients included in the study, K. pneumoniae predominates, accounting for 44.2%, and the total treatment cost for this organism was the highest at 202731.5 dollars. The maximum duration of hospitalization was recorded in patients from whom A. baumannii was isolated (27.7 days).&#x0D; Conclusions. The resistance of strains isolated from patients has directly contributed to the extension of the hospitalization period. The resistance of A. baumannii and K. pneumoniae species has predominantly led to the increase in the economic burden of AMR.

Dairy farmers’ levels of awareness of antibiotic use in livestock farming in Pakistan

Antimicrobial resistance due to the irrational and non-sustainable use of antimicrobials poses a serious threat to animal health, human health and urban food security. This study aimed to access the knowledge and perceptions of dairy farmers regarding antimicrobial use and misuse in Lahore, Pakistan. This is the first study regarding antibiotic misuse in Lahore, Pakistan. A random sample of 270 dairy farmers from urban and suburban areas of Lahore participated in an interview-based survey conducted in 2019–20. The results were analyzed using SPSS version 16. About 22% of farmers do not consult a veterinarian, 32.9% do not follow correct dosage instructions and 39% discontinue treatment once the disease signs subside. Moreover, 40% of farmers were unaware of the dangers of misusing antibiotics and admitted to saving leftover antibiotics for future use. Alarmingly, over 20.7% of respondents share antibiotics with friends/farmers and 43% sought advice from non-veterinarian sources. Furthermore, 90% of farmers perceived self-medication as more economical than consulting a veterinarian. Dairy farmers have a wrong perception of antibiotic efficacy, use, expertise of veterinarians and cost of antibiotics. The absence of a food policy and lack of antibiotic use guidance is a serious gap in Pakistan. Antibiotic dispensing laws need to be developed and strictly implemented. Awareness campaigns need to be launched so that farmers get knowledge regarding the uses, overuse and misuse of antibiotics. A holistic approach is essential to address the potential food security crisis caused by non-sustainable farming practices. Policymakers must take action to bridge the gap in the Pakistani food supply chain and promote the sustainable use of antimicrobials/antibiotics.

Burden of nosocomial infections in intensive care units: Cost of antibiotics, the extra length of stay and mortality rate.

Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients' condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients' information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China.

To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.

The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review.

Antimicrobial resistance (AMR) is a major global health threat, increasing deaths and healthcare costs. Antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use and curb resistance. This systematic review aimed to summarize evidence on the role and impact of pharmacists in hospital ASPs. A comprehensive literature search was conducted across databases to identify relevant studies published from 2016 to 2023. Twenty-four studies met the inclusion criteria, comprising global observational and randomized clinical trials. Pharmacists performed various stewardship activities, including prospective audits, formulary management, de-escalation, guideline development, and education. Pharmacist-led interventions significantly improved antibiotic prescribing, reduced unnecessary antibiotic use, optimized therapy, and enhanced outcomes. Multiple studies found that pharmacist reviews decreased the time to optimal antibiotics and improved guideline compliance without affecting readmissions or revisits. De-escalation programs safely reduced antibiotic duration and length of stay. Acceptance rates for recommendations were high. Pharmacist stewardship curbed overall antibiotic use, costs, and duration across hospital departments, leading to savings. While most studies showed positive impacts, fewer detected significant changes in resistance or mortality over short periods. More research is needed, but current evidence demonstrates that pharmacists play critical roles in ASPs, leading to improved antibiotic use and patient outcomes. These findings support integrating pharmacists into stewardship activities, significantly extending programs to ambulatory settings.

Benefits of Accepting Infectious Diseases Pharmacist Recommendations: A 5-Year Outcome Study in a Multihospital System.

Background: Infectious diseases (ID) pharmacists are pivotal members of antimicrobial stewardship teams. Prospective audit and feedback is a strong recommendation by The Infectious Diseases Society of America Guidelines for Antimicrobial Stewardship Programs (ASP). Utilizing customized ASP intervention documentation tools known as "ivents" in Epic, we aimed to assess the impact of interventions by measuring outcomes that were accepted compared to those that were rejected in a multihospital health system over 5 years. Methods: A multicenter, retrospective cohort study was conducted to compare clinical outcomes among intensive care unit (ICU) and non-ICU patients with accepted and rejected ASP interventions over 5 years from October 2015 to December 2020. Outcomes measured included antibiotic days of therapy per 1000 patient days (DOT/1000 PD), antibiotic doses per 1000 patient days (doses/1000 PD), hospital length of stay (LOS), in-hospital mortality, hospital-acquired Clostridioides difficile infection (HA-CDI), community-onset C. difficile infection (CO-CDI) within 30 days, and hospital readmission within 30 days. Coarsened exact matching (CEM) was used as a non-parametric matching method to balance covariates between groups and to control for confounding. Results: ASP recommendations by ID pharmacists were well-received by providers in a multihospital system over 5 years as evidenced by an overall acceptance rate of 92%. Acceptance of ASP interventions was associated with substantial reductions in antibiotic utilization without adversely affecting mortality or hospital readmissions. While high-risk C. difficile antibiotic use increased significantly due to frequent de-escalation to ceftriaxone among non-ICU patients with accepted interventions, rates of HA-CDI and CO-CDI within 30 days did not worsen. Furthermore, hospital LOS was notably shorter by an average of 1 day for non-ICU patients with accepted interventions, which resulted in substantial cost avoidance of $7 631 400. Conclusion: Collaboration with ID pharmacists to optimize antimicrobial stewardship was associated with significant reductions in antibiotic utilization, costs, and hospital LOS without worsening patient outcomes.

Attitudes and practices on antibiotic use and its emerging threats among Lebanese dairy veterinarians: a case study from a developing country.

This study aimed to explore how veterinarians (vets) rationalized their prescribing decisions for antimicrobial (AM) uses, the barriers they perceived to implement proper farm management in Lebanon, and the consecutive threats that might arise concerning the emergent spread of antimicrobial resistance in animals and the population. Amid the COVID-19 pandemic, phone call interviews were conducted with 34 veterinarians working in different demographic regions across the country. Data were analyzed qualitatively using an inductive thematic analysis. The majority of veterinarians called for responsible antibiotic use. The prescribing decision of veterinarians was based mainly on suspected disease from field examination, farmer's reports via phone calls, and the ability of the farmer to cover antibiotic costs. Very few veterinarians referred to laboratory diagnosis before prescribing a specific AM due to many obstacles. This study uncovered the absence of a trust relationship between veterinarians and farmers in Lebanon. Veterinarians provided different insights into farming practices, reflecting that farmers, in general, lack proper knowledge and implementation of farm management and that they mainly treat the herd on their own, especially in light of the current unprecedented economic crisis that Lebanon has been facing in the last three years. Above all, veterinarians revealed that AM resistance in Lebanon is markedly spreading, which calls for a serious and instantaneous set of governmental policies and regulations.

2803. The Medical Trends and Economic Burden of XDR Typhoid Compared to Non-XDR Typhoid: A Single Center Retrospective Study from Karachi, Pakistan

Abstract Background In 2016, Pakistan reported the first outbreak of an Extensively Drug Resistant (XDR) typhoid showing susceptibility only to Meropenem and Azithromycin which created a treatment dilemma and raised concerns not only in developing countries but also globally. In this study, we compared the medical trends and economic burden of XDR typhoid with non-XDR typhoid at a tertiary care hospital of Karachi, Pakistan. Methods A retrospective study was conducted at the Sindh Infectious Diseases Hospital &amp; Research Centre Karachi, Pakistan from June 2022 to April 2023. All hospitalized patients 14 years and above with confirmed Salmonella typhi on blood culture were included. Medical records were reviewed for clinical data and antibiotic cost. Statistical analysis was done using SPSS. Results Thirty-five patients were included of which 23 (65.7%) had XDR typhoid while 12 (34.3%) patients had non-XDR typhoid. Of the 12 non-XDR typhoid cases, nine were MDR (Multi Drug Resistant) while three had ampicillin sensitive strain. The mean age was 21.14 years with 27 (77.1%) males. Compared to non-XDR, majority of the XDR typhoid patients had diarrhea (60.9% vs. 16.7%, p-value= 0.02, OR 7.7, 95% CI: 1.3-44.0). XDR typhoid was treated with either Meropenem alone or Meropenem and Azithromycin combination while MDR typhoid was treated with Ceftriaxone. The time to defervescence was prolonged in XDR typhoid compared to non-XDR typhoid (7.95 days vs. 4.67 days, p-value= 0.007, OR 1.6, 95% CI: 1.14-2.3), with higher per day cost of antibiotics and total inpatient-antibiotic cost (US$20.3 vs. US$11, p-value= 0.006, OR 1.4, 95%CI 1.1-1.9) and (US$193 vs. US$139, p-value= 0.048] respectively. Within XDR group, the mean defervescence time was more in patients who received combined Meropenem and Azithromycin compared to Meropenem alone group (10.1 days vs 6.4 days, p-value=&amp;lt; 0.001) with a consequent higher per day in-patient antibiotic cost (USD$22 vs USD$ 18.8, p-value= &amp;lt; 0.001) and total in-patient cost (USD$ 235 vs. USD$ 158K, p-value= 0.009). Conclusion XDR typhoid has emerged not only as a heath care but also as an economic challenge owing to its prolonged defervescence time and increased per day/ total in-patient antibiotic cost. Disclosures All Authors: No reported disclosures

1394. Antibiotics Overuse and Cost Analysis among Hospitalized Dengue Virus Infected-Thai Adults.

Abstract Background Dengue is a common cause of acute febrile illness, predominantly in Asia which required supportive treatment without antibiotics. The antibiotics overuse leads to antimicrobial resistance threats. This study aimed to determine the use of antibiotics and cost analysis of hospitalized dengue virus infected-Thai adults. Methods This retrospective cohort study was conducted in Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand in 2022. All confirmed dengue adults’ cases during 2016-2021 were evaluated by two independent reviewers. Clinical, microbiological characteristics and medical costs per episode were interested outcome. The overuse was defined as inappropriate antibiotics prescription in terms of indications, choices, duration, dosage, or route administration. Factors associated with antibiotics overuse were evaluated using a Poisson regression. Direct medical and non-medical costs per episode also were analysed. Results A total of 249 participants were included. More than half were classified as severe or dengue with warning signs upon admission. Nearly 20% were transferred to or admitted at intensive care unit. The cumulative incidence of antibiotics use was 9.3% (95% confidence interval (CI): 8.23–10.47), which majority were empirically given. Of 38.3% among empirical antibiotics given participants showed no definite concurrent bacterial infections. The cumulative incidence of antibiotics overuse was 49.8% (95% CI: 43.42–56.18) mainly thanks to no indications of antibiotics. There was association between disease severity upon admission and antibiotics overuse (p-value 0.014). Median total medical cost was 1,086.6 USD per episode; meanwhile, median cost of antibiotics use was 10.8 USD per episode. There was significant difference of antibiotics cost between overuse and appropriate use (p-value 0.005). Conclusion The antibiotics overuse in hospitalized dengue virus infected-Thai adults was high. Doctors in charge should reconsider presumed concurrent bacterial infection before empirical antibiotics administration. Antimicrobial stewardship should be also endorsed in dengue cases or other tropical infectious diseases to control resistance threats and hospitalized medical costs. Disclosures All Authors: No reported disclosures

Chemical profiling and inhibitory effects of selected South African plants against phytopathogenic bacteria and fungi of tomato

Soilborne pathogens are economically important, causing great losses in agricultural production globally. The high cost and toxicity of antibiotics, coupled with the development of drug-resistant bacteria, has awakened interest in finding alternative methods of plant-pathogen control. This study aimed to screen extracts of selected plants against phytopathogenic bacteria and fungi that infect tomatoes, and to profile their chemical constituents. The antimicrobial activity of acetone, water and dichloromethane: methanol (DCM/MeOH = 1:1) extracts from leaves of ten plants was examined against five phytopathogenic bacterial strains and one fungal strain using a serial microplate dilution method to determine the minimal inhibitory concentration (MIC) values. Gas chromatography-mass spectrometry (GC–MS) was used for profiling constituents in the acetone and DCM/MeOH extracts. The MIC values indicated weak antibacterial activity of all the water extracts against tested bacterial strains. Acetone and DCM/MeOH extracts of Leucosidea sericea and Searsia lancea had very good to outstanding antibacterial activity against most of the tested bacteria with MIC values ranging between 19.5 and 78 µg/mL. All extracts were not active against Fusarium spp. except for the acetone extract of Cotyledon orbiculata and the water extract of Leonotis leonurus which inhibited the growth of F. oxysporum with MIC = 39 and 97.5 µg/mL after 24 h, with further incubation resulting in MICs of 156 and 469 µg/mL respectively. The GC–MS analysis of the acetone and DCM/MeOH extracts indicated the major peaks of 9-octadecenamide, (Z)-, octadecanoic acid and dodecanamide which were present in almost all the extracts. The 9-octadecenamide was found to be the most highly concentrated compound in most extracts. Leucosidea sericea and S. lancea, therefore, contain bioactive compounds that may be used as broad-spectrum antimicrobials against phytopathogenic bacteria and fungi.

160 Effect of Diets Containing Soybean Co-Products Formulated for High-Risk Stocker Cattle on Growth Performance, Morbidity and Mortality Associated with Respiratory Disease

Abstract The objectives of this study were to determine the effect of including soybean co-products on growth performance and respiratory disease incidence in high-risk stocker cattle. For this study, crossbred beef bulls and steers [n = 272; initial body weight (BW) 230.9 ± 19.7 kg] were purchased from local auction markets at 3 time points (load 1: n = 93 cattle; load 2: n = 91 cattle; load 3: n = 88 cattle). On day 0, cattle were processed (ear tagged, vaccinated, dewormed, ear notched for identification of cattle persistently infected with bovine viral diarrhea virus, castrated intact bulls), stratified by BW and allocated randomly to 1 of 8 pens (0.45 ha). Pens were assigned randomly to 1 of 3 dietary treatments: 1) a control supplement containing no soy co-products (CON); 2) a supplement containing soybean meal (SBM); or 3) a supplement containing soy oil (SBO). All supplements were isonitrogenous and isoenergetic. Cattle were fed supplements (2.45 kg DM/day) and offered bermudagrass hay for ad libitum intake for a 42-day trial. Body weights were taken on days 14, 28, 41, and 42 of the trial. Each morning, cattle were observed for signs of morbidity. If presenting with symptoms, cattle were pulled and rectal temperatures were recorded; if temperature exceeded 40°C, calves were treated according to a standard protocol. Cattle were deemed chronic if they received 3 antibiotic treatments and had an overall average daily gain (ADG) of less than 0.5 kg/d. Statistical analyses were performed using SAS 9.4, with PROC MIXED used for BW, ADG, and antibiotic cost analysis. Body weights were analyzed with the repeated measure of day and for treatment, day, and treatment by day interaction. PROC GLIMMIX was used for morbidity and mortality analyses. There was no treatment by day interaction (P = 0.99) or main effect of treatment (P = 0.86), but there was a day effect (P &amp;lt; 0.0001) with BW increasing throughout the trial. Average daily gain was not affected by treatment (P ≥ 0.42; 0.81 kg/d for SBM, 0.79 kg/d for SBO, and 0.76 kg/day for CON). Overall morbidity and mortality were 71% and 1%, respectively, and were not affected by treatment (P = 0.62 and P = 0.99, respectively). Relapse rates and chronics were not affected by treatment (P = 0.52 and P = 0.51, respectively). Total cost of antibiotic treatments was not different (P = 0.8; $30.37 for SBO, $28.95 for CON, and $28.52 for SBM). While the inclusion of soybean co-products did not affect BW, respiratory disease incidence, or cost of antibiotic treatments in high-risk stocker cattle, further work will focus on haptoglobin, hemocytology, and antibody titer responses during the receiving period.

Overview of Availability, Cost, and Affordability of Antibiotics for Adults in Jordan: An AWaRe Classification Perspective.

Antimicrobial resistance (AMR) poses a global public health threat, with rates directly linked with consumption. The World Health Organization (WHO)'s AWaRe classification aims to guide antibiotic use, and is influenced by drug availability, affordability, and economic policies. In Jordan, a high proportion of consumed antibiotics belong to the 'Watch' category. Data from the WHO's AWaRe classification, the Essential Medicines List, and the Jordan Food and Drug Administration were analyzed. Antibiotics for adults were classified, their costs per defined daily dose (DDD) were determined and their affordability assessed. In 2023, 43 injectable and 43 oral antibiotics for adults were registered in Jordan. 'Watch' antibiotics were the most common. 'Access' antibiotics had the lowest cost/DDD. 'Reserve' antibiotics were the most expensive, with few generics. Injectable antibiotics had a negative correlation between cost and the number of alternatives. Affordability was higher for oral antibiotics compared with injectable ones. 'Reserve' antibiotics were generally unaffordable. This study highlights the need to promote 'Access' antibiotics over other categories by encouraging the registration of missing 'Access' antibiotics and adjusting the prices of 'Watch' and 'Reserve' antibiotics. Competition among generics can lead to lower prices, increasing affordability and accessibility. We emphasize the importance of the AWaRe classification in guiding antibiotic use in Jordan.

Ultrasound-guided percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage versus debridement with closed suction irrigation for treating deep surgical site infection after spinal surgery.

It is difficult to avoid deep surgical site infection after spinal surgery. Debridement combined with closed suction irrigation (CSI) and other treatment methods lead to greater trauma and lower satisfaction. We developed a new method for the treatment of SSI, which has the advantages of less invasiveness and lower cost. The cohort of this retrospective study comprised 26 patients with SSI after undergoing spinal surgery in our hospital from August 2017 to March 2022. The patients were divided into CSI and microtube drainage group according to treatment methods. The durations of antibiotic use and hospital stay, hospitalization costs, and functional scores during follow-up were compared between the two groups. The only baseline characteristic that differed between the two groups was sex. Infection was controlled in both groups and there were no recurrences during follow-up. However, the length of hospital stay after the first operation and the total length of stay were significantly greater in the CSI group. Hospitalization costs and antibiotic costs were significantly higher in the CSI group. Additionally, the duration of intravenous antibiotic use was significantly longer in the CSI group. Both the CSI and microtube drainage groups had significantly improved of Short Form Health Survey (SF-36) scores 6 months postoperatively. However, 3 months postoperatively, SF-36 scores were significantly lower in the CSI group. Compared with debridement followed by CSI, percutaneous micro-drainage tube irrigation combined with high negative pressure tube drainage is a more efficient and economical means of treating SSI after spinal surgery.

The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy

Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) =18.0, p<0.001) and LND (OR = 21.0, p=0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.

Comparative effectiveness of cefmetazole versus carbapenems and piperacillin/tazobactam as initial therapy for bacteremic acute cholangitis: A retrospective study

IntroductionCarbapenems and piperacillin/tazobactam (PIPC/TAZ) are commonly used as the initial therapy to treat extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in acute cholangitis. However, the overuse of these antibiotics contributes to the spread of antimicrobial resistance. Cefmetazole (CMZ) is stable to hydrolysis by ESBLs, so it may be an alternative to carbapenems and PIPC/TAZ. However, the effectiveness of CMZ compared with that of carbapenems and PIPC/TAZ as the initial therapy for acute cholangitis is unknown. MethodsWe conducted a retrospective cohort study at a university hospital between April 1, 2014, and December 31, 2022. Patients with bacteremic acute cholangitis who received CMZ, carbapenems, or PIPC/TAZ as the initial therapy were included. The patients were divided into a CMZ group and a carbapenems or PIPC/TAZ (CP) group to compare patient outcomes. ResultsA total of 99 patients (54 in the CMZ group and 45 in the CP group) were analyzed. The baseline characteristics of the patients were similar and 30-day mortality did not differ between groups (4% vs. 7%, P = 0.66). However, the CMZ group had a shorter length of stay (LOS) (8 days vs. 15 days, P < 0.001) and lower mean antibiotic cost (98.92 USD vs. 269.49 USD, P < 0.001) than the CP group. ConclusionsIn bacteremic acute cholangitis, initial therapy with CMZ may contribute to a shorter LOS and lower antibiotic costs than treatment with carbapenems and PIPC/TAZ, without worsening patient outcomes.

The impact of antimicrobial stewardship on reserve antibiotic use and procuring cost

Background: Antimicrobial Stewardship (AMS) is an intervention designed to optimise the appropriate use of antibiotics is expected to reduce selective pressure on microbes, control antimicrobial resistance, improve patient clinical outcomes, and cost reduction. Objective: The aim of this study is to analyse the impact of antimicrobial stewardship on "reserve" antibiotics use and procuring cost of antibiotics in hospitals. Method: The study was conducted at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. A retrospective observational design study to analyse trends of "reserve" antibiotics use and procuring cost before AMS implementation (January 2018-December 2019) and after AMS implementation (January 2020-December 2021). Results: The total meropenem consumption before AMS intervention in January 2018-December 2019 was 9950 DDD, and after AMS intervention in January 2020-December 2021 was 4639 DDD, showing a decrease of 53 %. Procuring Meropenem cost in 2018-2019 was Indonesian Rupiah (IDR) 1.490 billion and IDR 309 million between 2020 to 2021. Cost reduction positively impacts saving procurement costs in hospitals of IDR 1.18 billion (79%). Conclusion: The impact antimicrobial stewardship programs can reduce reserve antibiotic use with meropenem indicator and have a sustainable economic impact, saving the cost of procuring antibiotics in hospitals.