Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

Abstract

Background Antibiotic resistance (ABR) is one of the biggest threats to global health. Infections by ESKAPE ( Enterococcus , S. aureus , K. pneumoniae , A. baumannii , P. aeruginosa , and E. coli ) organisms are the leading cause of healthcare-acquired infections worldwide. ABR in ESKAPE organisms is usually associated with significant higher morbidity, mortality, as well as economic burden. Directing attention towards the ESKAPE organisms can help us to better combat the wide challenge of ABR, especially multi-drug resistance (MDR). Objective This study aims to systematically review and evaluate the evidence of the economic consequences of ABR or MDR ESKAPE organisms compared with susceptible cases or control patients without infection/colonization in order to determine the impact of ABR on economic burden. Methods Both English-language databases and Chinese-language databases up to 16 January, 2019 were searched to identify relevant studies assessing the economic burden of ABR. Studies reported hospital costs (charges) or antibiotic cost during the entire hospitalization and during the period before/after culture among patients with ABR or MDR ESKAPE organisms were included. The costs were converted into 2015 United States Dollars. Disagreements were resolved by a third reviewer. Results Of 13,693 studies identified, 83 eligible studies were included in our review. The most studied organism was S. aureus , followed by Enterococcus , A. baumannii , E. coli , E. coli or/and K. pneumoniae , P. aeruginosa , and K. pneumoniae . There were 71 studies on total hospital cost or charge, 12 on antibiotic cost, 11 on hospital cost or charge after culture, 4 on ICU cost, 2 on hospital cost or charge before culture, and 2 on total direct and indirect cost. In general, ABR or MDR ESKAPE organisms are significantly associated with higher economic burden than those with susceptible organisms or those without infection or colonization. Nonetheless, there were no differences in a few studies between the two groups on total hospital cost or charge (16 studies), antibiotic cost (one study), hospital cost before culture (one study), hospital cost after culture (one study). Even, one reported that costs associated with MSSA infection were higher than the costs for similar MRSA cases. Conclusions ABR in ESKAPE organisms is not always, but usually, associated with significantly higher economic burden. The results without significant differences may lack statistical power to detect a significant association. In addition, study design ...

High-throughput laboratory evolution and evolutionary constraints inEscherichia coli

“…The emergence of antibiotic resistance and multidrug-resistant bacteria is a growing global health concern (May, 2014;O'Neill, 2016;Suk et al, 2019;Zhen et al, 2019), and methodology to suppress the emergence of resistant bacteria is desired. Various mechanisms for antibiotic resistance have been identified, including the activation of efflux pumps, modifications of specific drug targets, and shifts in metabolic activities (Harder et al, 1981;Okusu et al, 1996;Palmer and Kishony, 2014;Toprak et al, 2011;Yelin and Kishony, 2018;Zampieri et al, 2017).…”

Antibacterial Compounds from Mushrooms: A Lead to Fight ESKAPEE Pathogenic Bacteria?

“…Global data are alarming: drug-resistant infections are responsible for one death every 45 s in the world [13]. Besides this high increase in mortality and morbidity rates, antibiotic resistance also generates a high additional economic burden, reaching up to 20 billion dollars for the U. S. healthcare system [12,14,15].…”

Defeating Antibiotic-Resistant Bacteria: Exploring Alternative Therapies for a Post-Antibiotic Era

“…Therefore, antibiotic resistance is one of the most serious global public health threats of the 21st century. The World Health Organization has highlighted that antibiotic resistance in clinical treatment, if left to persist at the current rate, may lead to 10 million deaths and a reduction of 2-3.5% gross domestic product annually by 2050 [2,3]. Among antibiotic resistant bacteria, "ESKAPE" pathogens, including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species [4], cause the majority of hospital infections with higher mortality of patients.…”

“…Among antibiotic resistant bacteria, "ESKAPE" pathogens, including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species [4], cause the majority of hospital infections with higher mortality of patients. "ESKAPE" pathogens effectively escape the effects of commonly used antibacterial drugs, and are usually associated with significantly higher economic burden by increasing the duration of hospital stays and deceasing workforce productivity [3,5]. Recently, a notable study reported that ESKAPE pathogens represented 42.2% of species isolated from bloodstream infections in the United States [5].…”