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 present investigation was carried out during two successive Cabbage seasons (2016-2017 and 2017- 2018), to study the impact of entomopathogenic fungi on Brevicoryne brassica L. The aphid ...Populations were evaluated in the field early in the season in December 2016 which began to appear on cabbage plants. Thereafter number of aphids increased gradually to reach a peak of abundance during December 2016 & 2017 and January 2017 & 2018). Three concentrations were used (1 x105, 1 x 106 and 1 x 107 spores/ ml.). Under laboratory conditions, the results showed that V. lecanii, M. anisopliae, and B. bassiana have high toxicity and mortality rates occurred after 3rd day from treatment. The maximum percent of mortality (100 %) occurred after the 10th day from treatment with the 3rd concentration in V. lecanii. The 3rd concentration (1 x 107spores/ ml.) was highly toxic in V. lecanii, B. bassiana, and M. anisopliae to the adult of Brevicoryne brassica L. compared with the other two concentrations.Under field conditions, the third concentration (1 x 107) also, was the best concentration against Brevicoryne brassica L. after the third application in V. lecanii, B. bassiana, and M. anisopliae. The percent of reduction was ranged between 93.3 to 99.2% and 92.0 to 97.7 in the high concentrations, in the two seasons, respectively. V. lecanii and B. bassiana were highly effective than M. anisopliae against Brevicoryne brassica L. These results confirmed that V. lecanii, B. bassiana, and M. anisopliae isolates are promising agents for Brevicoryne brassica L. control in the field.
A 13‐year‐old Egyptian girl with generalized hypertrichosis, gingival hyperplasia, coarse facial appearance, no cardiovascular or skeletal anomalies, keloid formation, and multiple labial frenula was ...referred to our clinic for counseling. Molecular analysis of the ABCC9 gene showed a de novo missense mutation located in exon 27, which has been described previously with Cantu syndrome. An overlap between Cantu syndrome, acromegaloid facial syndrome, and hypertrichosis acromegaloid facial features disorder is apparent at the phenotypic and molecular levels. The patient reported here gives further evidence that these syndromes are an expression of the ABCC9‐related disorders, ranging from hypertrichosis and acromegaloid facies to the severe end of Cantu syndrome.
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.
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