Costs and benefits of diagnostic and therapeutic methods in Salmonella infections

Abstract

Type and number of specific diagnostic procedures; type, time and exitus of therapy were studied in the management of 335 hospitalized patients with Salmonella infection during a nine/years period (1976-1984). Sixty-three cases of S. typhi (18.8%), 26 of S. paratyphi B (7.7%), 48 of S. typhimurium (14.3%) and 198 other Salmonella species (59.1%) were identified. Positive cultures were obtained from blood in 18.8% of cases. In typhoid fever bacteriemia was detected in 60.3% of cases. The sensitivity of microorganisms to antibiotics was detected. Of 281 (83.8%) patients treated with "major" antibiotics (CAF, Ampicillin or Co-trimoxazole) clearance of Salmonella was obtained in 171 (60.8%). Stool "acidification" with lactulose was attempted in 54 patients (16.2%), of which 20 (37%) became negative. Charges of the bacteriologic cultures, serological tests, antibiotics and supportive therapy were estimated in order to assess the cost/benefit ratio of patients care. Length of stay and chemotherapy were respectively 20.7 (11-18) and 11 (7-17) days. Maximal cost/case ratio occurs in diagnosis for stool cultures, in therapy for Ampicillin. The introduction of an economic approach to use diagnostic and therapeutic procedures has significantly improved the management of Salmonella infections from 1976 to 1984.