br Economics consequences of antibiotic resistance in a SICU
Economics consequences of antibiotic resistance in a SICU In the era of cost-containment, surgeons also need to consider the economic impact of antibiotic resistance in the surgical patient. Antibiotic-resistant infections are more difficult to treat, are more costly and more likely to be fatal than those that are susceptible to antibiotics. Researchers from a large academic medical center analyzed the costs of responding to a MDR Acinetobacter outbreak in a 10-bed general surgery ICU and 10-bed trauma ICU. Nine cases of MDR Acinetobacter occurred over a 9-week period and resulted in excess cost estimates of $371,079 or $41,000 of unnecessary expenses per patient. The greatest contributors to the cost were the extra resources needed to staff and clean the two ICUs that were shut down. Almost 400 excess hours were spent by hospital leadership, surgical directors, infection control staff, and patient care leaders in meetings resulting in an additional estimated $40,000 of costs based on salary and benefit calculations. Excluded from the cost analysis were any financial impact of operating room case cancellations, changes in staff morale and patient satisfaction, litigation, loss of reimbursement, and the impact on the hospital’s reputation.
Introduction The use of prophylactic indole butyric acid sale is a common practice in surgical fields to prevent perioperative and periprocedural infections . With increasing awareness of antibiotic stewardship in light of emerging antibiotic-resistant microbes, assessing the indications and rationale for antibiotic use is ever more important , , . Although there is literature focusing on the use of prophylactic antibiotics for adult urologic procedures, the evidence for using antibiotics following common pediatric urologic procedures is limited with no specific guidelines on its use . Consequently, current practices on antibiotic usage for common interventions may be variable among practicing pediatric urologists (PUs), lacking evidence based support. This study aims to define and evaluate the current practices on antibiotic use for common pediatric urological interventions among PUs practicing across four distinct English-speaking communities in the Western world. Given the lack of consensus regarding antibiotic prophylaxis in pediatric urology, we hypothesize that there will be a wide variation in patterns of prophylactic antibiotics use among the four communities.
Materials and methods Using pediatric urologists' opinions from around the world for face and content validity, we developed an anonymous multiple-choice survey. Each question on the survey represented a clinical scenario involving use of antibiotic prophylaxis for a specific urologic procedure, with three multiple choice options for type of antibiotic prophylaxis: “treatment dose,” “prophylaxis dose,” and “no antibiotic use” (Supplementary appendix S1). After approval by our Institutional Research Ethics Board (no. 1000056522), all active members of the Pediatric Urologists of Canada (PUC) and the Society of Pediatric Urology of Australia and New Zealand (SPUNZA) were invited via email to participate in the survey online (http://www.surveymonkey.com). After an initial email was sent, two reminder emails were sent until response rates reached at least 65%. The cut-off of 65% was determined based on the current recommendations by most clinical journals that suggest ≥60% of response rates should be achieved to minimize response bias and to support the validity of the survey findings . The responses for each scenario were summarized for overall practice pattern variation. Moreover, practice pattern differences among PUs from different parts of the world (Canada, Australia and New Zealand, United States, and United Kingdom) were compared with each other using the Fisher exact test, yielding six different comparisons per scenario. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) Software (Version 20.0.0). We assumed two-sided alternative hypothesis and the level of significance was set at p = 0.05.