Sandra Oeyen

Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection

This study analysed daily antimicrobial costs of Intensive Care Unit (ICU)-acquired, laboratory-confirmed bloodstream infection (BSI) per patient admitted to the ICU of a university hospital, based on prospectively collected data over a 4-year period (2003-2006). Costs were calculated based on the price of the agent(s) initiated on the first day of appropriate treatment and according to: (i) focus of infection; (ii) pathogen; and (iii) antimicrobial agent. The study included 310 adult patients who developed 446 BSI episodes. Mean overall daily antimicrobial cost was euro114.25. Daily antimicrobial cost was most expensive for BSIs with unknown focus (euro137.70), followed by catheter-related (euro122.73), pulmonary (euro112.80), abdominal (euro98.00), wound (euro89.21), urinary (euro87.85) and other inciting focuses (euro81.59). Coagulase-negative staphylococci were the most prevalent pathogens isolated. Treatment of BSIs caused by Candida spp. was the most costly. The daily antimicrobial costs per infected patient with multidrug-resistant BSI was ca. 50% higher compared with those without (euro165.09 vs. euro82.67; P<0.001). Among the total of 852 prescriptions, beta-lactam antibiotics accounted for approximately one-third of the overall daily cost of antimicrobial agents. The antibiotic cost associated with ICU-acquired, laboratory-confirmed BSI is significant and should be reduced by implementing infection control measures and preventive strategies.

Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit

Abstract Acute kidney injury (AKI) in patients hospitalized in the intensive care unit (ICU) results in increased morbidity, mortality, and as a consequence, higher health-care costs. The bad prognosis associated with this condition and limited health-care budgets both have raised the issue of how much therapy should be dedicated to ICU patients with AKI. As no universally-agreed standardized definition for AKI is available, wide ranges of incidence are reported and precise estimates of its associated excess of costs are, therefore, difficult to explore. Nonetheless, significantly prolonged hospital length of stay (LOS) and higher costs in ICU patients whose course was complicated with AKI are reported. Moreover, among survivors, even greater requirements of in-hospital and post-hospitalization care was noted. Notwithstanding the high health-economic burden, full supportive intensive care treatment is justified in this particular cohort of patients. Major efforts are highly required in terms of public health prevention initiatives and the early recognition and timely management of AKI, in ICU hospitalized patients in particular.

A 50-year-old man with severe hypercalcemia: a case report.

Abstract Objective: We present this case to emphasize the importance of early diagnosis and treatment of an acute severe hypercalcemic syndrome due to primary hyperparathyroidism as a consequence of an undiagnosed adenoma of the parathyroid gland. Case report: A 50-year-old man presented at another hospital with non-specific symptoms such as anorexia, nausea, vomiting, polyuria, dehydration, abdominal pain, weight loss, fatigue, muscular weakness, irritability and lethargy. Serum levels of calcium and parathyroid hormone (PTH) were markedly increased to 23.6 mg/dL1* (reference values 8.6-10.2 mg/dL) and >1900 ng/L (reference values 14-72 ng/L) respectively. After initial treatment, the patient was transferred to the intensive care unit (ICU) of a tertiary care university hospital for further stabilization and treatment because the typical signs of hypercalcemia were not resolving. A parathyroid adenoma was diagnosed and a few days later a parathyroidectomy was performed. The postoperative course was uneventful and the patient could be discharged from the hospital in a good general condition. Conclusion: Acute primary hyperparathyroidism, also known as parathyroid storm or parathyroid crisis, is a rare but potentially fatal endocrine emergency if unrecognized and untreated. Appropriate diagnosis and immediate adequate management of hypercalcemia are important in reducing mortality. Nevertheless, mortality remains high, even with surgical treatment which is the cornerstone of the definitive therapy.

About protocols and guidelines: it's time to work in harmony!

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Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.