Introduction: Selective decontamination of the digestive tract (SDD) is effective in reducing infectious complications in elective colorectal cancer (CRC) surgery. However, it is unclear whether SDD is cost-effective compared to standard antibiotic prophylaxis.
Material & Methods: Economic evaluation alongside multicenter randomized controlled trial, the SELECT-trial, from a healthcare perspective. Patients included underwent elective surgery for non-metastatic CRC. The intervention group received oral non-absorbable colistin, tobramycin and amphotericin B (SDD) next to standard antibiotic prophylaxis. Both groups received a single shot intravenous cefazolin and metronidazole preoperatively as standard prophylaxis. Occurrence of postoperative infectious complication in the first 30 postoperative days was extracted from medical records, Quality-Adjusted Life-Years (QALYs) based on the ED-5D-3L, and healthcare costs collected from the hospital's financial administration.
Results: Of the 455 patients, 228 were randomly assigned to intervention group and 227 patients to the control group. SDD significantly reduced the number of infectious complications compared to control (difference = -0.13, 95 % CI -0.05 to -0.20). No difference was found for QALYs (difference = 0.002, 95 % CI -0.002 to 0.005). Healthcare costs were statistically significantly lower in the intervention group (difference = -€1258, 95 % CI -2751 to -166). The ICER was -9872 €/infectious complication prevented and -820,380 €/QALY gained. For all willingness-to-pay thresholds, the probability that prophylactic SDD was cost-effective compared to standard prophylactic practice alone was 1.0.
Conclusion: The addition of SDD to the standard preoperative intravenous antibiotic prophylaxis is cost-effective compared to standard prophylactic practice from a healthcare perspective and should be considered as the standard of care.
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http://dx.doi.org/10.1016/j.ejso.2023.107116 | DOI Listing |
Crit Care Explor
January 2025
Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Objectives: The COVID-19 pandemic gave rise to uncertainty concerning potential sequelae related to a severe acute respiratory syndrome coronavirus 2 infection. This landscape is currently unfolding with studies reporting sequelae on various domains (physical, cognitive, and psychosocial), although most studies focus on adults or only one domain. We sought to investigate concurrent sequelae on multiple domains 1 year after PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C).
View Article and Find Full Text PDFCureus
December 2024
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, THA.
Infectious complications in peritoneal dialysis (PD) remain a constant challenge, with atypical pathogens posing significant risks. This case from Thailand highlights the rare occurrence of , an often-overlooked non-tuberculous mycobacterium (NTM), as the causative agent in a catheter-related exit-site infection that progressed to peritonitis. Initially misattributed to from preceding exit-site infections, was ultimately identified as the primary pathogen through multiple effluent cultures and advance polymerase chain reaction sequencing.
View Article and Find Full Text PDFRespir Med Case Rep
December 2024
Central RI [Research Institute] of Epidemiology, Federal Service for the Oversight of Consumer Protection and Welfare (Rospotrebnadzor), Moscow, Russia.
According to WHO, dengue fever (DF) is currently endemic to more than 100 countries in various regions of Africa, America, and Asia; outbreaks have been reported in Europe. In the Russian Federation, there is a much smaller proportion of children among those infected due to the imported nature of the infection. We described a clinical case of imported dengue fever in an adolescent girl in Moscow after a 5-day vacation.
View Article and Find Full Text PDFWorld J Orthop
January 2025
Department of Orthopedics, The 940 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou 730000, Gansu Province, China.
Background: Tuberculosis is among the most devastating infectious diseases worldwide. Spinal tuberculosis is not easy to detect at an early stage, which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia. In this study, we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging, general observations, and histopathological and bacteriological studies.
View Article and Find Full Text PDFExpert Rev Anti Infect Ther
January 2025
Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Spain.
Introduction: Lower respiratory infections have a huge impact on global health, especially in older individuals, immunocompromised people, and those with chronic comorbidities. The COVID-19 pandemic highlights the importance of vaccination. However, there are lower rates of vaccination in the adult population that are commonly due to a missed opportunity to vaccinate.
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