Clinical and Economic Impact of Bacteremia with Extended- Spectrum-β-Lactamase-Producing Enterobacteriaceae

Abstract

We studied outcomes of extended-spectrum ␤-lactamase (ESBL) production in Enterobacteriaceae bacteremia. Inpatients with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella spp., or Proteus spp. (cases) were compared with patients with bacteremia caused by non-ESBL producers (controls). Outcomes included mortality, mortality due to infection, length of stay (LOS), delay in appropriate therapy (DAT), discharge to a chronic care facility, and hospital cost. Ninety-nine cases and 99 controls were enrolled. Thirty-five percent of cases died, versus 18% of controls (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3 to 4.7; P ‫؍‬ 0.01). Thirty percent of cases died due to infection, versus 16% of controls (OR, 2.3; 95% CI, 1.1 to 4.5; P ‫؍‬ 0.03). The median LOS after bacteremia for cases was 11 days (interquartile range, 5 to 21), versus 5 days for controls (interquartile range, 3 to 9) (P < 0.001). DAT occurred in 66% of cases, versus 7% of controls (OR, 25.1; 95% CI, 10.5 to 60.2; P < 0.001). Cases were more likely than controls to be discharged to chronic care (52% versus 21%; OR, 4.0; 95% CI, 1.9 to 8.3; P < 0.001). The average hospital cost for cases was 65,509 Israeli shekels, versus 23,538 shekels for controls (P < 0.001). After adjusting for differences between groups by using multivariable analysis, ESBL production remained a significant predictor of mortality (OR, 3.6; 95% CI, 1.4 to 9.5; P ‫؍‬ 0.008), increased LOS (1.56-fold; P ‫؍‬ 0.001), DAT (OR, 25.1; 95% CI, 10.5 to 60.2; P < 0.001), and increased cost (1.57-fold; P ‫؍‬ 0.003). The mean increase in equivalent cost attributable to ESBL production was $9,620. ESBL production was associated with severe adverse outcomes, including higher overall and infection-related mortality, increased LOS, DAT, discharge to chronic care, and higher costs.

A Study on Prevalence and Antimicrobial Resistance Pattern of Urinary Klebsiella pneumoniae in a Tertiary Care Centre in South India

“…The cost of hospitalization and duration of stay and mortality rate are higher with ESBL producing strains of Klebsiella spp. than non-ESBL producing Klebsiella spp (Schwaber et al, 2006;Kim et al, 2002). ESBL producing Klebsiella pneumoniae isolated were 17.5% almost the same results were obtained in the other studies (Romero et al, 2007;El Bouamri et al, 2015).…”

Multidrug-Resistant Gram-Negative Bacteria among Patients Who Require Chronic Hemodialysis

“…In the past few years, however, a concerning increase in the prevalence of infections caused by multidrug-resistant gram-negative bacteria (MDRGN) has been documented in other patient populations (4 -6). Infections that are caused by these MDRGN are associated with up to five times higher mortality rates compared with infections that are caused by susceptible gram-negative bacteria (7). Among chronic hemodialysis patients, approximately 25% of blood stream infections are caused by gram-negative bacteria (8), and this percentage is increasing steadily (9).…”

Carriage of ESBL- and AmpC-positive Enterobacteriaceae in the gastrointestinal tract of community subjects and hospitalized patients in the Czech Republic

“…Of particular clinical importance are ESBL (extended-spectrum beta-lactamase) and AmpC enzymes capable of hydrolyzing penicillins, monobactams and cephalosporins with a broad spectrum of activity. From a clinical point of view, the danger of ESBL-and AmpC-positive Enterobacteriaceae is that they increase the risk of antibiotic treatment failure, mortality and economic costs of treatment of infections with the etiological role of bacteria [1][2][3][4] . From an epidemiological perspective, the distribution of genetic types of ESBLs has changed significantly since they were first described in 1983 (ref.…”