Our aim was to examine whether the length of stay, hospital charges and in-hospital mortality attributable to healthcare- and community-associated infections due to antimicrobial-resistant bacteria ...were higher compared with those due to susceptible bacteria in the Lebanese healthcare settings using different methodology of analysis from the payer perspective .
We performed a multi-centre prospective cohort study in ten hospitals across Lebanon. The sample size consisted of 1289 patients with documented healthcare-associated infection (HAI) or community-associated infection (CAI). We conducted three separate analysis to adjust for confounders and time-dependent bias: (1) Post-HAIs in which we included the excess LOS and hospital charges incurred after infection and (2) Matched cohort, in which we matched the patients based on propensity score estimates (3) The conventional method, in which we considered the entire hospital stay and allocated charges attributable to CAI. The linear regression models accounted for multiple confounders.
HAIs and CAIs with resistant versus susceptible bacteria were associated with a significant excess length of hospital stay (2.69 days 95% CI,1.5-3.9; p < 0.001) and (2.2 days 95% CI,1.2-3.3; p < 0.001) and resulted in additional hospital charges ($1807 95% CI, 1046-2569; p < 0.001) and ($889 95% CI, 378-1400; p = 0.001) respectively. Compared with the post-HAIs analysis, the matched cohort method showed a reduction by 26 and 13% in hospital charges and LOS estimates respectively. Infections with resistant bacteria did not decrease the time to in-hospital mortality, for both healthcare- or community-associated infections. Resistant cases in the post-HAIs analysis showed a significantly higher risk of in-hospital mortality (odds ratio, 0.517 95% CI, 0.327-0.820; p = 0.05).
This is the first nationwide study that quantifies the healthcare costs of antimicrobial resistance in Lebanon. For cases with HAIs, matched cohort analysis showed more conservative estimates compared with post-HAIs method. The differences in estimates highlight the need for a unified methodology to estimate the burden of antimicrobial resistance in order to accurately advise health policy makers and prioritize resources expenditure.
The objective of this study is to identify and characterize the species resistance of different pathogens between community acquired and hospital acquired infections pointing at patients’ related ...independent co-morbidities and socio-demographic factors.
It was a retrospective cohort, multicenter study from five private hospitals located in Beirut and Mount Lebanon. Two hundred fifty-eight adult patients were included.
110 Gram negative pathogens and 26 Gram positive pathogens were implicated in hospital acquired infections. The Gram-negative bacteria that showed a positive correlation regarding patient’s type of infection were Pseudomonas aeruginosa (12%), Klebsiella pneumoniae (6.2%) and Acinetobacter baumannii (3.1%). These bacteria were more frequent in patients with hospital acquired infections (P=0.002, 0.013 and 0.017 respectively). The ratio of methicillin resistant Staphylococcus aureus, Extended Spectrum Beta Lactamase producing Escherichia coli and K. pneumoniae and multi drug P. aeruginosa showed high significance in hospital acquired infections. The logistic regression, showed a significant relationship between resistant bacteria and age (p<0.001, ORa=5.680, CI 2.344; 13.765) and immunosuppressed state (p=0.003, ORa=3.137, CI 1.485; 6.630) and an inverse relationship for Chronic Obstructive Pulmonary Disease (COPD) (p=0.006, ORa=0.403, CI 0.212; 0.765).
Our results confirm that hospital acquired infections/bacteria have higher rates of resistance when compared to community acquired; these rates increase with age, immunosuppression and are inversely proportional with COPD. Therefore, physicians should be aware of patients’ comorbidities to properly guide initial therapy.
The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary ...considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer’s perspective.
A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality.
Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality.
In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
•Urinary tract infections (UTIs) resulting from antibiotic-resistant Escherichia coli have been associated with a high economic burden and health strain compared with susceptible isolates.•In developing countries, despite the high prevalence of antimicrobial resistance, data are scarce and limited in their scope.•In Lebanon, no study to date has estimated the burden of this potentially avoidable condition. Quantifying the burden of UTIs can highlight the impact of resistance on sustainable development and potentially give policy makers an incentive to invest in quality improvement and national preventive programs.
The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary ...considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer’s perspective.
A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality.
Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality.
In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
•Urinary tract infections (UTIs) resulting from antibiotic-resistant Escherichia coli have been associated with a high economic burden and health strain compared with susceptible isolates.•In developing countries, despite the high prevalence of antimicrobial resistance, data are scarce and limited in their scope.•In Lebanon, no study to date has estimated the burden of this potentially avoidable condition. Quantifying the burden of UTIs can highlight the impact of resistance on sustainable development and potentially give policy makers an incentive to invest in quality improvement and national preventive programs.
In this paper, we consider decentralized optimization problems where agents have individual cost functions to minimize subject to subspace constraints that require the minimizers across the network ...to lie in low-dimensional subspaces. This constrained formulation includes consensus or single-task optimization as special cases, and allows for more general task relatedness models such as multitask smoothness and coupled optimization. In order to cope with communication constraints, we propose and study an adaptive decentralized strategy where the agents employ differential randomized quantizers to compress their estimates before communicating with their neighbors. The analysis shows that, under some general conditions on the quantization noise, and for sufficiently small step-sizes <inline-formula><tex-math notation="LaTeX">\mu</tex-math></inline-formula>, the strategy is stable both in terms of mean-square error and average bit rate: by reducing <inline-formula><tex-math notation="LaTeX">\mu</tex-math></inline-formula>, it is possible to keep the estimation errors small (on the order of <inline-formula><tex-math notation="LaTeX">\mu</tex-math></inline-formula>) without increasing indefinitely the bit rate as <inline-formula><tex-math notation="LaTeX">\mu \rightarrow 0</tex-math></inline-formula> when variable-rate quantizers are used . Simulations illustrate the theoretical findings and the effectiveness of the proposed approach, revealing that decentralized learning is achievable at the expense of only a few bits.
Background
Yolk sac tumor or endodermal sinus tumor is an uncommon malignant germ cell neoplasm. This tumor usually presents in childhood or young adulthood as a testicular or ovarian mass. ...Extragonadal sites such as mediastinal, intracranial, and sacrococcygeal have been described. A review of the literature revealed limited related cases. The clinical presentation, radiographic characteristics, operative findings, and patient outcomes are discussed.
Case presentation
We report the occurrence of a primary paraspinal germ cell tumor in a 28-month-old boy who presented with thoracic spinal cord compression. The patient presented with pain, weakness, paraplegia, and bowel and bladder disturbances.
MRI was done and showed a retroperitoneal and paravertebral mass invading the left diaphragmatic crus, the lateral neural foramen, and the posterior paravertebral muscles. Morphologic and immunohistochemical features were consistent with a germ cell tumor, namely an endodermal sinus tumor (yolk sac) of the epidural area. The final diagnosis was determined to be stage IV extragonadal germ cell tumor. The patient underwent emergency surgery consisting of T10–12 laminectomy and epidural mass resection with the release of the spinal cord compression and received chemotherapy consisting of cisplatin, bleomycin, and etoposide. After six cycles of chemotherapy, follow-up MRI showed complete resolution of the tumor. The patient has been in complete remission 16 years from his initial diagnosis. He still, however, has mild residual weakness in both lower extremities and some detrusor-sphincter dyssynergia.
Conclusion
Extragonadal germ cell tumors presenting with spinal cord compression are rare; however, they should be included in the differential diagnosis of every child younger than 3 years old who does not present with the typical features. Germ cell tumors are sensitive to platinum-based chemotherapy, and surgery should only be performed for spinal cord compression and for obtaining tissue biopsy for a definitive diagnosis. The sooner the decompression is done, the better neurological outcome is achieved. Long-term remission, and possibly cure, can be achieved with a multidisciplinary treatment strategy.
Communication-constrained algorithms for decentralized learning and optimization rely on local updates coupled with the exchange of compressed signals. In this context, differential quantization is ...an effective technique to mitigate the negative impact of compression by leveraging correlations between successive iterates. In addition, the use of error feedback, which consists of incorporating the compression error into subsequent steps, is a powerful mechanism to compensate for the bias caused by the compression. Under error feedback, performance guarantees in the literature have so far focused on algorithms employing a fusion center or a special class of contractive compressors that cannot be implemented with a finite number of bits. In this work, we propose a new decentralized communication-efficient learning approach that blends differential quantization with error feedback. The approach is specifically tailored for decentralized learning problems where agents have individual risk functions to minimize subject to subspace constraints that require the minimizers across the network to lie in low-dimensional subspaces. This constrained formulation includes consensus or single-task optimization as special cases, and allows for more general task relatedness models such as multitask smoothness and coupled optimization. We show that, under some general conditions on the compression noise, and for sufficiently small step-sizes \(\mu\), the resulting communication-efficient strategy is stable both in terms of mean-square error and average bit rate: by reducing \(\mu\), it is possible to keep the estimation errors small (on the order of \(\mu\)) without increasing indefinitely the bit rate as \(\mu\rightarrow 0\). The results establish that, in the small step-size regime and with a finite number of bits, it is possible to attain the performance achievable in the absence of compression.
In this paper, we consider decentralized optimization problems where agents have individual cost functions to minimize subject to subspace constraints that require the minimizers across the network ...to lie in low-dimensional subspaces. This constrained formulation includes consensus or single-task optimization as special cases, and allows for more general task relatedness models such as multitask smoothness and coupled optimization. In order to cope with communication constraints, we propose and study an adaptive decentralized strategy where the agents employ differential randomized quantizers to compress their estimates before communicating with their neighbors. The analysis shows that, under some general conditions on the quantization noise, and for sufficiently small step-sizes \(\mu\), the strategy is stable both in terms of mean-square error and average bit rate: by reducing \(\mu\), it is possible to keep the estimation errors small (on the order of \(\mu\)) without increasing indefinitely the bit rate as \(\mu\rightarrow 0\). Simulations illustrate the theoretical findings and the effectiveness of the proposed approach, revealing that decentralized learning is achievable at the expense of only a few bits.
PDF
