Cost Attributable to Nosocomial Bacteremia. Analysis According to Microorganism and Antimicrobial Sensitivity in a University Hospital in Barcelona

AimTo calculate the incremental cost of nosocomial bacteremia caused by the most common organisms, classified by their antimicrobial susceptibility.MethodsWe selected patients who developed nosocomial bacteremia caused by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Pseudomonas aeruginosa. These microorganisms were analyzed because of their high prevalence and they frequently present multidrug resistance. A control group consisted of patients classified within the same all-patient refined-diagnosis related group without bacteremia. Our hospital has an established cost accounting system (full-costing) that uses activity-based criteria to analyze cost distribution. A logistic regression model was fitted to estimate the probability of developing bacteremia for each admission (propensity score) and was used for propensity score matching adjustment. Subsequently, the propensity score was included in an econometric model to adjust the incremental cost of patients who developed bacteremia, as well as differences in this cost, depending on whether the microorganism was multidrug-resistant or multidrug-sensitive.ResultsA total of 571 admissions with bacteremia matched the inclusion criteria and 82,022 were included in the control group. The mean cost was € 25,891 for admissions with bacteremia and € 6,750 for those without bacteremia. The mean incremental cost was estimated at € 15,151 (CI, € 11,570 to € 18,733). Multidrug-resistant P. aeruginosa bacteremia had the highest mean incremental cost, € 44,709 (CI, € 34,559 to € 54,859). Antimicrobial-susceptible E. coli nosocomial bacteremia had the lowest mean incremental cost, € 10,481 (CI, € 8,752 to € 12,210). Despite their lower cost, episodes of antimicrobial-susceptible E. coli nosocomial bacteremia had a major impact due to their high frequency.ConclusionsAdjustment of hospital cost according to the organism causing bacteremia and antibiotic sensitivity could improve prevention strategies and allow their prioritization according to their overall impact and costs. Infection reduction is a strategy to reduce resistance.     

Effects of Food Intake on Numbers of Salmonellae and Escherichia coli in Rumen and Faeces of Sheep

When 10⁷–10⁸ Salmonella anatum or Salm. typhimurium were inoculated into the rumen of sheep consuming 1·3 kg of lucerne chaff daily, salmonellae were eliminated from the rumen in 2 days, and could not be detected in the faeces after c. 1 week. During starvation, both Escherichia coli and salmonellae grew in the rumen. Resumption of feeding after starvation for 3 days caused further multiplication of E. coli and salmonellae in the rumen. The organisms were subsequently eliminated with further feeding. Inoculation with as few as 400 salmonellae cells into a starved sheep led to large numbers of salmonellae appearing in the faeces and being excreted in varying numbers for at least 5 weeks after resumption of feeding.     

A Comparison of Methods for the Enrichment of Salmonellae from Sheep Faeces

S ummary : A 10-tube MPN technique was used to test the efficiency of nutrient, tetrathionate, mannitol-selenite and mannitol-selenite-cystine broths as enrichment media for detecting salmonellae. Small numbers of broth grown salmonellae could be detected in all 4 media in the presence of 5% of sheep faeces. In naturally infected sheep faeces small numbers of salmonellae were not detected with either nutrient or tetrathionate broths. With mannitol-selenite the sensitivity of salmonella detection increased with both incubation temperature (37–43°) and the addition of faeces. The most sensitive and reliable medium for detecting salmonellae in naturally infected sheep faeces was mannitol-selenite-cystine broth. Neither incubation temperature (37–43°) nor the addition of faeces had a statistically significant effect on its sensitivity.     

Fatty acid profile of the cabbage looper, Trichoplusia ni, and the effect of diet and rearing conditions

The fatty acids, palmitic (16:0), palmitoleic (16:1), stearic (18:0), oleic (18:1), linoleic (18:2), and linolenic (18:3) were measured by GLC in Trichoplusia ni (Hübn.) from larvae reared on three different diets. The effect of rearing temperature and humidity on the levels of these fatty acids in pupae and pharate adults was determined. T. ni tended to accumulate 18:3 somewhat in proportion to its level in the diet. The respective levels (relative percentage) of this fatty acid in the diet and in the pupae were: bean leaves, 73·6 and 56·7; the diet based on lima beans, 10·2 and 3·5; and a meridic diet containing wheatgerm oil, 5·6 and 1·8. Pupae from larvae reared on a diet marginal in 18:3 content produced adults with deformed wings when reared at 30°C and normal wings when reared at 23 or 24°C, but there was no difference in their tissue level of 18:3. The phospholipids of last instar larvae, pharate pupae, pupae, pharate adults, and emerged adults are made up mostly of 18:0, 18:2, and 18:3 while the triglycerides of these stages contain relative large quantities of 16:0, 16:1, and 18:1. Pupal rearing temperature did not appear to influence the level of 18:3 in these two fractions enough to account for the degree of deficiency expressed as adult wing deformity. Both high (95%) and low (20%) relative humidity have an adverse effect on wing development but this effect can be overcome by 18:3 supplementation of the larval diet.     

Pathology: Tumor Necrosis Factor in Human Disease

The Scientific Board of the California Medical Association presents the following inventory of items of progress in pathology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in pathology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Pathology of the California Medical Association, and the summaries were prepared under its direction.     

Pattern control in insect segments: superimposed features of the pattern may be subject to different control mechanisms

Summary The integument of an insect segment displays two distinct pattern features which are based on different properties of the constituent epidermal cells. Normally, the uniform orientation of epidermal cell polarities (polarity pattern) is strictly correlated with the sequence of differentiated cells (differentiation pattern). Here it is reported that in the integument of the cotton bug Dysdercus epidermal cells can adopt orientations that do not correlate with the pigmentation pattern and which are not compatible with the gradient model. The results indicate that different features of a composite pattern can be independently controlled.     

Influence of environmental manipulation and nest-box availability on reproductive success of captive cockatiels (Nymphicus hollandicus)

Environmental conditions greatly influenced breeding induced by nest-box presentation in pair-bonded cockatiels. Thirty-six pairs were first held under nonstimulatory environmental conditions for 13 weeks. To provide potential breeding cues, photoperiod, light intensity, ambient temperature, and humidity were then increased over a 12-day period; millet was replaced by a nutritionally adequate, crumbled diet; and nest-boxes were presented. Compared to previous trials performed under more constant conditions, number of pairs laying eggs, pair-day egg production, clutch size, and chick hatch weight were significantly increased. In experiment 2, either millet or crumbled diet was fed to 36 pairs during a 9-week nonstimulatory period. Both groups were then exposed to stimulatory environments, fed crumbled diet, and presented with nest-boxes. Their reproductive performances were not different, indicating that diet change was not required to stimulate breeding. In experiment 3, birds were fed crumbled diet throughout the trial. Nest-boxes were presented to 31 pairs during nonstimulatory conditions (group 1) or to 28 pairs during the transition to stimulatory conditions (group 2). Percent of pairs laying (85.7 v. 16.7), pair-day egg production (0.279 ± 0.036 v. 0.036 ± 0.014), and clutch size (9.1 ± 1.0 v. 4.6 ± 1.2) were greater in group 2, indicating that nest-box presentation is an insufficient stimulus to evoke maximal breeding under nonstimulatory environmental conditions.     

Prevalencia de obesidad y riesgo cardiovascular asociado en la población general de un área de salud de Extremadura. Estudio Hermex

Introduction and objectivesTo estimate the prevalence of obesity and its associated cardiovascular risk in the general population of a health area in Extremadura.Materials and methodsA cross-sectional study on a random population sample aged 25-79 years from the Don Benito-Villanueva (Badajoz) health area. Risk factors and cardiovascular disease were examined. Anthropometric and blood pressure measurements were collected, and a blood sample was taken. Obese subjects were categorized into different risk levels as proposed by the Spanish Society for the Study of Obesity, and the influence of obesity on estimation of the risk of ischemic heart disease was studied using the Framingham function, as adapted for Spain.ResultsA total of 2833 of the 3521 subjects screened (80.5%) participated in the study. Mean age was 51.2 years (SD 14.7), and 46.5% were males. Male subjects had a greater prevalence of overweight and obesity (46.2% and 37.7% respectively) as compared to females (37.7% and 32.6%) (p<0.005 and p<0.05 respectively). Only 10% of obese subjects had no increased cardiovascular risk. Obesity was associated to an 8-fold increase in the presence of a high risk for ischemic heart disease in females (p<0.001), as compared to a 1.4-fold increase in males (p=0.095).ConclusionsObesity is highly prevalent and affects, together with overweight, 74.1% of the population in an Extremadura health area. A vast majority of obese subjects have an increased cardiovascular risk, which is very marked for ischemic heart disease in females.