1. 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
- Author
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Hos , Andrew J, Allignol , Arthur, Beyersmann , Jan, Graves , Nicholas, Schumacher , Martin, Hos , Rodolphe, Hos , Evelina, Hos , Giulia, Hos , Claudio, Hos , Fabio, Bertrand , Xavier, Gbaguidi-Haore , Houssein, Edgeworth , Jonathan, Tosas , Olga, Hos , Jose A, Hos , M Pilar, Pan , Angelo, Zoncada , Alessia, Hos , Charis A, Hos , Dilip, Seifert , Harald, Hos , Nina, Hagel , Stefan, Pletz , Mathias, Harbarth , Stephan, Meyer , Rodolphe, Tacconelli , Evelina, De Angelis , Giulia, Farina , Claudio, Pezzoli , Fabio, Martinez , Jose A, Ayala-Blanco , M Pilar, Marwick , Charis A, Nathwani , Dilip, Freiburg Center for Data Analysis and Modeling, University of Freiburg [Freiburg], Laboratoire de Biologie Moléculaire et Cellulaire du Cancer, Hôpital Kirchberg, Fondation de Recherche Cancer et Sang - Hôpital Kirchberg, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Divisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Department of Ophthalmology, Friedrich-Alexander-University of Erlangen-Nuremberg, Feinberg School of Medicine, Northwestern University, Department of Pulmonary Medicine, Hannover Medical School [Hannover] ( MHH ), Infection Control Programme and WHO Collaborating Centre on Patient Safety, Department of Infectious Diseases, Università Cattolica del Sacro Cuore, INFN Laboratori Nazionali di Legnaro, Unità di Microbiologia, AO 'Ospedale San Carlo Borromeo', Hospital Papa Giovanni XXIII ( Hosp P Giovanni XXIII ), Groupe d'histoire et diffusion des sciences d'Orsay ( GHDSO ), Université Paris-Sud - Paris 11 ( UP11 ), Laboratoire Interdisciplinaire de Recherche en Didactique, Éducation et Formation ( LIRDEF ), and Université Paul-Valéry - Montpellier 3 ( UM3 ) -Université de Montpellier ( UM )
- Subjects
Staphylococcus aureus ,MESH : Retrospective Studies ,MESH : Male ,MESH : Europe ,MESH : Aged ,bloodstream infection ,MESH : Treatment Outcome ,Antimicrobial resistance ,MESH : Hospital Mortality ,multidrug resistance ,[ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology ,MESH : Enterobacteriaceae Infections ,Escherichia coli ,MESH : Methicillin-Resistant Staphylococcus aureus ,MESH : Female ,MESH : Middle Aged ,MESH : Anti-Bacterial Agents ,MESH : Cephalosporin Resistance ,MESH : Staphylococcus aureus ,MESH : Humans ,MESH : Enterobacteriaceae ,MESH : Proportional Hazards Models ,MESH : Hospitals ,MESH : Length of Stay ,bacterial infections ,MESH : Staphylococcal Infections ,Meticillin-resistant Staphylococcus aureus (MRSA) in humans ,MESH : Health Care Costs - Abstract
International audience; 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.
- Published
- 2016