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The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study

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ABSTRACT

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

No MeSH data available.


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Multistate model adopted for the analysis of the burden of bloodstream infections caused by antimicrobial resistance, 2010–2011
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f1: Multistate model adopted for the analysis of the burden of bloodstream infections caused by antimicrobial resistance, 2010–2011

Mentions: Two important characteristics of this dataset were the inclusion of time-varying exposures (BSI, surgery and ICU admission) and competing risks (death and discharge alive). We adopted the multistate model illustrated in Figure 1 to explicitly account for these characteristics [4]. Patients entered the initial state on admission to acute care and exited by entering one of two competing absorbing states (hospital death or discharge alive), with or without passing through one of two intermediate states (susceptible or non-susceptible BSI). Admissions were artificially right-censored at day 45 to reduce the influence of outliers. We reasoned that patients with such prolonged admissions were likely to remain hospitalised for other reasons not influenced by BSI.


The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study
Multistate model adopted for the analysis of the burden of bloodstream infections caused by antimicrobial resistance, 2010–2011
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998424&req=5

f1: Multistate model adopted for the analysis of the burden of bloodstream infections caused by antimicrobial resistance, 2010–2011
Mentions: Two important characteristics of this dataset were the inclusion of time-varying exposures (BSI, surgery and ICU admission) and competing risks (death and discharge alive). We adopted the multistate model illustrated in Figure 1 to explicitly account for these characteristics [4]. Patients entered the initial state on admission to acute care and exited by entering one of two competing absorbing states (hospital death or discharge alive), with or without passing through one of two intermediate states (susceptible or non-susceptible BSI). Admissions were artificially right-censored at day 45 to reduce the influence of outliers. We reasoned that patients with such prolonged admissions were likely to remain hospitalised for other reasons not influenced by BSI.

View Article: PubMed Central - PubMed

ABSTRACT

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

No MeSH data available.


Related in: MedlinePlus