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

Giulia De Angelis, Evelina Tacconelli, Andrew J. Stewardson, A. Allignol, J. Beyersmann, N. Graves, M. Schumacher, R. Meyer, C. Farina, F. Pezzoli, X. Bertrand, H. Gbaguidi-Haore, J. Edgeworth, O. Tosas, J. A. Martinez, M. P. Ayala-Blanco, A. Pan, A. Zoncada, C. A. Marwick, D. NathwaniH. Seifert, N. Hos, S. Hagel, M. Pletz, S. Harbarth, Cristina Masuet-Aumatell, Marta Banqué Navarro, Chiara Falcone

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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 cephalosporinsusceptible 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.
Original languageEnglish
Pages (from-to)5-16
Number of pages12
JournalEurosurveillance
Volume21
DOIs
Publication statusPublished - 2016

Keywords

  • Aged
  • Anti-Bacterial Agents
  • Antimicrobial resistance
  • Cephalosporin Resistance
  • Enterobacteriaceae
  • Enterobacteriaceae Infections
  • Escherichia coli
  • Europe
  • Female
  • Health Care Costs
  • Hospital Mortality
  • Hospitals
  • Humans
  • Length of Stay
  • Male
  • Methicillin-Resistant Staphylococcus aureus
  • Meticillin-resistant Staphylococcus aureus (MRSA) in humans
  • Middle Aged
  • Proportional Hazards Models
  • Retrospective Studies
  • Staphylococcal Infections
  • Staphylococcus aureus
  • Treatment Outcome
  • bacterial infections
  • bloodstream infection
  • multidrug resistance

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