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Hospital-acquired infections: benchmarks and statistics

About 13 percent of high-risk adult patients developed healthcare-acquired infections (HAI) in 2000, according to the (Roberts, et al. 2010)  study of 1,253 patients.  The total costs attributable to HAI ranged up to $21,000 per patient and an increase in length of stay of about 6 to 10 days was found.  Healthcare-acquired infection was found to double hospital cost.  In a study based on a review of the published literature, (Scott, 2009) concluded that the direct medical cost to the nation of HAI ranges from about $28 billion to $34 billion each year.  The (Edwards, et al. 2009) article reports data from a large-scale study of the prevalence of central line associated bloodstream infections, urinary catheter-associated urinary tract infections, and ventilator-associated pneumonia.  This article, out of the National Healthcare Safety Network, provides mean, median, and percentile rates for these HAIs for different types of units within hospitals.

Sources:  Roberts RR, and others.  Costs attributable to healthcare-acquired infection in hospitalized adults and a comparison of economic methodsMedical Care;48(11):1026-1035, Nov. 2010. 

Scott, R.D., II.  The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.  U.S. Centers for Disease Control and Prevention, Mar. 2009.  Free full text here: http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

Edwards, J.R., and others.  National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009.  American Journal of Infection Control;37:783-805, Dec. 2009.  Free full text here: http://www.cdc.gov/nhsn/PDFs/dataStat/2009NHSNReport.PDF

One Response

  1. HIV-sites


    Julian Lieb, M.D



    Stimulating defective immune function to perform efficiently is a desirable approach to defeating pathogens. Such stimulation is represented as unavailable, while in truth the immunostimulating properties of lithium and antidepressants were documented many years ago.1-4 A therapeutic claim is reinforced when the mechanism is known. Prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. Wherever HIV comes into contact with arachidonic acid, an envelope glycoprotein powerfully converts this precursor to prostaglandin E2, depressing immune function and promoting viral replication, excessive prostaglandin E2 a leading candidate for the immunosuppression that is the hallmark of AIDS.5-7 Antidepressants inhibit the synthesis of prostaglandin E2, antagonize its actions, and stimulate the primary prostaglandin-degrading enzyme.8-10

    Collective evidence shows that lithium has acute immunostimulating, anti-viral, and anti-bacterial properties, 11 antidepressants chronic immunostimulating, anti-viral, anti-bacterial,1-4 anti-parasite, and fungicidal properties.12-15 Tuberculosis, now the #1 killer of the HIV infected, is developing resistance to standard treatment. In the late nineteen forties, physicians working in tuberculosis sanitaria observed patients with elevations of mood and energy. Their charts revealed that all were taking the monoamine oxidase inhibitors isoniazid or iproniazid, an observation from which antidepressant therapy developed. If anti-tuberculosis agents double as antidepressants, surely antidepressants must double as anti-tuberculosis agents? The antimalarial properties of antidepressants in vitro are supported by many studies.12 When added to anti-retrovirals, antidepressants can reduce HIV viral loads to undetectable.16 The authors of this study attribute this to adherence, seemingly unaware of the antiviral properties of antidepressants. The advantage of immunostimulation is its non-specificity, a stimulated immune system indifferent to antigenicity.

    People with intact immune function are relatively invulnerable to pathogens, compared to those with defective function. Depression is a seldom mentioned cause of defective immunity, although indices of immune function indicate that it does so.17 In a study of 405 HIV-positive gay and bisexual men, those who reported being depressed throughout the eight-year study period, were two-thirds more likely to die than those who were never significantly depressed.18,

    Forty years ago, prostaglandins were shown to regulate immune function, and lithium and antidepressants to inhibit prostaglandins. Gradually, prostaglandins were found to regulate every aspect of HIV replication, and HIV to stimulate prostaglandin E2 production, to a greater degree than other viruses. This prostaglandin, when produced excessively, is thought to be responsible for the immune depression that is the hallmark of AIDS. Twenty five years ago, I believed that lithium and antidepressants could be used as heavy artillery against HIV, but when lithium failed to improve patients with AIDS in two small clinical trials, came to favor antidepressants for this purpose. 19,20,21

    1. Lieb J. Remission of herpes virus infection and immunopotentiation with lithium carbonate: inhibition of prostaglandin E1 synthesis by lithium may explain its antiviral, immunopotentiating, and antimanic properties. Biol Psychiatry 1981; 695-698.

    2. Lieb J. Remission of rheumatoid arthritis and other disorders of immunity in patients taking monoamine oxidase inhibitors. Int J Immunopharmacol 1983; 5(4): 353-357.

    3. Rosenthal S, Fitch W. The antiherpetic effects of phenelzine. J Clin Psychopharmacol 1987; 7(2):119.

    4. Murphy D, Donnelly C, Moskowitz J. Inhibition by lithium of prostaglandin E1 and norepinephrine effects on cyclic adenosine monophosphate production in human platelets. Clin Pharmacol Ther 1973; 14(5):810-814.

    5. Lee R. The influence of psychotropic drugs on prostaglandin biosynthesis. Prostaglandins 1974; 5(1):63-68.

    6. Manku MS, Horrobin DF. Chloroquine, quinine, procaine, quinidine and clomipramine are prostaglandin agonists and antagonists. Prostaglandins 1976; 12: 789-801.

    7. Mak O, Chen S. Effects of two antidepressant drugs imipramine and amitriptyline on the enzyme activity of 15-hydroxyprostaglandin dehydrogenase purified from brain, lung, liver and kidney of mouse. Prog Lipid Res 1986; 25: 153-155.

    8. Fernandez-Cruz E, Gelpi E, Longo N, Gonzalez B, de la Morena, MT, Montes, MG,
    Rosello , J, Ramis I,Suarez A, Fernandez, A. Increased synthesis and production of prostaglandin E2 by monocytes from drug addicts with AIDS. AIDS 1989; 3: 93-96.

    9. Wahl L, Corcoran M, Pyle S, Pyle SW, Arthur LO, Harel-Bellan A, Farrar WL. Human immunodeficiency virus glycoprotein (gp120) induction of monocyte arachidonic acid metabolites and interleukin 1. Proc. Natl Acad. Sci. USA 1989; 86:621-625.

    10. Dumais N, Barbeau B, Olivier M, Tremblay MJ. Prostaglandin E2 up-regulates HIV-1 long terminal repeat-driven gene activity in T cells via NF-kappa B-dependent and–independent signaling pathways. J Biol Chem 1998; 273(42): 27306-27314

    11. Dutta P, Pinto J, Rivlin R. Antimalarial properties of imipramine and amitriptyline. J Protozool 1990; 37(1): 54-58.

    12. Lieb,J.”The immunostimulating and antimicrobial properties of lithium and antidepressants.” J Infection (2004) 49; 88-93

    13. Lass-Florl C, Dierich MP, Fuchs D, Semenitz E, Ledochowski M. Antifungal activity against Candida sp. by the selective serotonin reuptake inhibitor sertraline. Clin Infect Dis 2001; 33(12):E135-136.

    14. Munoz-Bellido J, Munoz-Criado S, Garcia-Rodriguez J. Antimicrobial activity of psychotropic drugs: selective serotonin reuptake inhibitors. Int J Antimicrob Agents 2000; 14(3): 177-180.

    15. Tsai A, Weiser S, Petersen M, Ragland K, Bangsberg D. Effect of antidepressant medication treatment on ARV adherence and HIV-1 RNA viral load in HIV+ homeless and marginally housed individuals. In: Program and abstracts of the 16th Conference on Retroviruses and Opportunistic Infections; February 8-11, 2009; Montréal, Canada. Abstract 584

    16. Frank M, Hendricks S, Johnson D, Wiesler J L, Burke WJ. Antidepressants augment natural killer cell activity: in vivo and in vitro. Neuropsychobiology 1999; 39(1):18-24.

    17. Mayne TJ, Vittinghoff E, Chesney MA, Barrett DC, Coates TJ. Depressive affect and survival among gay and bisexual men infected with HIV. Arch Intern Med. 1996 Oct 28; 156(19):2233-8.

    18. Lieb,J.”Stimulating immune function to kill viruses.” (And bacteria, parasites, and fungi). 2009, Amazon

    19. Evans DL, Ten Have TR, Douglas SD, Gettes DR, Morrison M, Chiappini MS, Brinker-Spence P, Job C, Mercer DE, Wang YL, Cruess D, Dube B, Dalen EA, Brown T, Bauer R, Petitto JMAssociation of depression with viral load, CD8 T lymphocytes, and natural killer cells in women with HIV infection. Am J Psychiatry. 2002 Oct; 159(10):1752-9.
    20. Evans DL, Lynch KG, Benton T, Dube B, Gettes Tustin NB, Lai JP, Metsger D, Douglas SD Selective serotonin reuptake inhibitor and substance P antagonist enhancement of natural killer cell innate immunity in human immunodeficiency virus/ acquired immunodeficiency syndrome. Biol Psychiatry 2008 May 1:63(9):899-905. Epub 2007 Oct 22.
    21. Benton T, Lynch K, Dube,B, Gettes DR, Tustin NB, Lai JP, Metsger DS, Blume J, Douglas SD, Evans DL. Selective Serotonin Reuptake Inhibitor Suppression of HIV Infectivity and Replication Psychosom Med 2010 Oct 14 {Epub ahead of print}
    . For educational purposes only, all treatment decisions to be made with a physician.

    Published by Hiv-sites on December 3, 2010

    Retirte Yale medical school professor

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