Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

Abstract

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Ongoing increasing temporal and geographical trends of the incidence of extended-spectrum beta-lactamase-producing Enterobacteriaceae infections in France, 2009 to 2013

“…This pathogen is the one of the most frequently isolated in both community and hospital-acquired urinary tract infections, and could be the cause of severe or fatal outcomes associated with bacteraemia, which has been shown to be increasing in France [27], with a significant increase in incidence of ESBL-E bacteraemia between 2009 and 2013 from 0.021 to 0.044 per 1,000 PD, respectively. The burden of ESBL-E bacteraemia, including E. coli, was reported in studies in several European counties (Austria, Belgium, Croatia, England, Germany, Greece, Ireland, Italy, Latvia, Malta, Romania, Scotland and Slovenia) in 2008 [26] and, more specifically, in Switzerland in 2009 to be five to seven excess days in hospital per hospital stay, at a cost of about 8,000 Euros per bacteraemia episode [2].…”

“…During this time, E. coli was the major pathogen among ESBL-E, especially in intensive-care units, where the incidence was double that seen in all other settings. Indeed, ESBL-E. coli poses a potential threat of high burden to HCF and related facilities (such as nursing homes and homebased hospital care) [2,26]. This pathogen is the one of the most frequently isolated in both community and hospital-acquired urinary tract infections, and could be the cause of severe or fatal outcomes associated with bacteraemia, which has been shown to be increasing in France [27], with a significant increase in incidence of ESBL-E bacteraemia between 2009 and 2013 from 0.021 to 0.044 per 1,000 PD, respectively.…”

“…In recent decades, the spread of multidrug-resistant organisms (MRO) has had a profound impact on healthcare facilities (HCF), combining a high mortality rate (16%) and financial burden per patient (5,000-10,000 Euros per episode of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) [1,2]. Multidrug resistance is a step towards a therapeutic dead-end and involves bacteria responsible for both healthcare-associated and community-acquired infections.…”

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

“…Regrettably, two seminal events occurred in the past 30 years, which have had a major impact on the therapy of infectious diseases. In a manner analogous to the HIV epidemic and its human toll, the evolution of extended-spectrum ␤-lactamases (ESBLs) 3 decades ago significantly crippled the activity of oxyimino-cephalosporins and aztreonam, followed by the more recent appearance of carbapenemases in the clinic, which has limited the efficacy of all currently available ␤-lactams, causing a staggering economic and human burden (1). We have learned that increased colonization pressure from carbapenemase-producing organisms (CPOs) is linked to the development of infection (2), and gastrointestinal carriage of ESBL-producing Enterobacteriaceae leads to subsequent infection (3).…”

Improved Treatment of Multidrug-Resistant Bacterial Infections: Utility of Clinical Studies

“…As summarized, for example, in a joint technical report from the EMA and European Centre for Disease Prevention and Control (ECDC), there is evidence that MDRO infections increase mortality, length of hospital stay and healthcare costs [2]. Furthermore, the clinical impact of ABR has been demonstrated for various types of infections [12][13][14]. Nevertheless, definitive estimates are not available and can vary in a large manner depending on first the methods used and second the clinical setting, the country and the resistant pathogen.…”