ESKAPE Pathogens in Bloodstream Infections Are Associated With Higher Cost and Mortality but Can Be Predicted Using Diagnoses Upon Admission

Abstract

Background ESKAPE bacteria are thought to be especially resistant to antibiotics, and their resistance and prevalence in bloodstream infections are rising. Large studies are needed to better characterize the clinical impact of these bacteria and to develop algorithms that alert clinicians when patients are at high risk of an ESKAPE infection. Methods From a US data set of >1.1 M patient encounters, we evaluated if ESKAPE pathogens produced worse outcomes than non-ESKAPE pathogens and if an ESKAPE infection could be predicted using simple word group algorithms built from decision trees. Results We found that ESKAPE pathogens represented 42.2% of species isolated from bloodstream infections and, compared with non-ESKAPE pathogens, were associated with a 3.3-day increase in length of stay, a $5500 increase in cost of care, and a 2.1% absolute increase in mortality (P < 1e-99). ESKAPE pathogens were not universally more resistant to antibiotics, but only to select antibiotics (P < 5e-6), particularly against common empiric therapies. In addition, simple word group algorithms predicted ESKAPE pathogens with a positive predictive value of 7.9% to 56.2%, exceeding 4.8% by random guessing (P < 1e-99). Conclusions Taken together, these data highlight the pathogenicity of ESKAPE bacteria, potential mechanisms of their pathogenicity, and the potential to predict ESKAPE infections upon admission. Implementing word group algorithms could enable earlier and targeted therapies against ESKAPE bacteria and thus reduce their burden on the health care system.

Epidemiology, Risk Factors and Outcomes of Bloodstream Infection Caused by ESKAPEEc Pathogens Among Hospitalized Children

“…The diagnosis criteria were determined by the de nitions of National Healthcare Safety Network and CDCP [19]. ESKAPEEc were previously de ned elsewhere [1][2]4,12]. The de nition of MRD was based on the international expert proposal for interim standard [20].…”

“…The notorious group of pathogens, Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp, named "ESKAPEEc" owing to their high resistances to multiple antimicrobial agents, have recently aroused global concern [1][2].Currently, the incidence of bloodstream infection (BSI) caused by ESKAPEEc has increased rapidly [3], and ESKAPEEc BSI brought about worse outcomes [3], longer hospital stays, higher economic costs [4][5][6], and increased mortality [4][5][6].In addition, effective antimicrobial agents against ESKAPEEc strains were limited due to the growth of resistance to multiple antibiotics in these bacterial species. Inappropriate and delayed empirical antimicrobial agents treatment for patients with BSI was connected with high risk of mortality [7][8][9][10].…”

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

“…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].…”

“…"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]. Moreover, compared with patients infected with non-ESKAPE pathogens, patients presenting ESPAKE-bloodstream infections were associated with a 3.3-day increase in length of hospital stay, and a 2.1% absolute increase in mortality [5].…”

“…Recently, a notable study reported that ESKAPE pathogens represented 42.2% of species isolated from bloodstream infections in the United States [5]. Moreover, compared with patients infected with non-ESKAPE pathogens, patients presenting ESPAKE-bloodstream infections were associated with a 3.3-day increase in length of hospital stay, and a 2.1% absolute increase in mortality [5].…”