In-hospital Medical Costs of Infections Caused by Carbapenem-resistant<i>Klebsiella pneumoniae</i>

Huang, Wenzhang; Qiao, Fei; Zhang, Yinying; Huang, Jing; Deng, Yuhua; Li, Jinwen; Zong, Zhiyong

doi:10.1093/cid/ciy642

Cited by 53 publications

(62 citation statements)

References 15 publications

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“…This study found that the median per capita total direct medical costs ($24940.1 vs. 16864.0, P = 0.017) and indirect economic loss ($3848.5 vs. 1139.9, P = 0.304) were higher in patients with CRE-BSI than with CSE-BSI, con rming that carbapenem resistance increased the economic burden of disease. This nding was consistent with studies showing that carbapenem resistance was associated with higher medical costs in patients infected with K. pneumoniae [29] and E. coli [30]. In addition, the median economic burden for hospitals of a single patient infected with CRE was about $59366.2, far more than the average person in China can afford.…”

Section: Discussionsupporting

confidence: 88%

“…Although hospital LOS was greater in the CRE-BSI than in the CSE-BSI group, the difference was not statistically signi cant. PSM that included LOS as a potential confounding variable resulted in a similar median LOS in the two groups, indicating that the effect of carbapenem-resistance on hospital LOS was due to longer hospital LOS before infection [29]. These ndings suggest that hospital LOS was unrelated to the increase in medical costs.…”

Section: Discussionmentioning

confidence: 75%

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Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Zhu¹,

Xiao²,

Wang³

et al. 2020

Preprint

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Background: Although infection with carbapenem-resistant Enterobacteriaceae (CRE) has become an urgent public health threat worldwide, the socioeconomic burden of CRE bloodstream infection (BSI) remains to be clarified.Methods: This retrospective study included all patients infected with Escherichia coli or Klebsiella pneumoniae who were hospitalized for BSI from 2013 to 2015. Socioeconomic burden, including direct and indirect economic burden, was compared in patients infected with carbapenem-sensitive Enterobacteriaceae (CSE) and CRE following 1:1 propensity score matching (PSM) to control for confounding variables. Results: Data from 879 patients with Enterobacteriaceae BSI were evaluated, including 152 (17.3%) patients infected with CRE and 727 (82.7%) infected with CSE. PSM yielded 112 pairs of 224 patients. Median hospital length of stay did not differ significantly in the CRE and CSE groups (35 vs. 29 days, P=0.089), but in-hospital 28-day mortality rate was significantly higher in patients infected with CRE than with CSE (45.5% vs. 32.1%, P =0.040). Median direct economic burden was significantly greater in patients with CRE-BSI than with CSE-BSI during hospitalization ($24940.1 vs. 16864.0, P=0.017) but not during the period after infection ($10403.4 vs. 8498.0, P=0.178). Drug expenditure accounted for the largest proportion of costs in both groups. The median disability-adjusted life year (DALY) was higher in CRE-BSI than in CSE-BSI patients, but the difference was not statistically significant (7.9 vs.6.7 years, P=0.190). Median indirect economic burden did not differ significantly in these two groups ($3848.5 vs.1139.9, P=0.304), although indirect economic burden increased significantly from 2013 to 2015 in patients with CRE-BSI.Conclusion: Carbapenem resistance had a major impact on the clinical and socioeconomic burden of patients with Enterobacteriaceae BSI. The higher mortality rate in patients with CRE-BSI was associated with increased direct healthcare burden and indirect socioeconomic loss.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 75%

Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Zhu¹,

Xiao²,

Wang³

et al. 2020

Preprint

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“…Thus, treatment with polymyxins such as colistin abandoned many years ago has been re-implicated as one of antibiotics of the last resort for CRKP infections. Recent studies reported that K. pneumoniae also became resistant to COL because of the prolonged or inappropriate treatments, and the monotherapy of colistin for CRKP infection caused some problems (Zhang et al, 2017;Huang et al, 2018). In our study, we found that the single antibiotic treatment of CRKP isolates from our hospital with exhibited considerable regrowth Treatment of CRKP isolates with COL at a dose of 250 µg/L did not kill the bacteria but exerted a bacteriostatic effect on 6 CRKP isolates.…”

Section: Discussionmentioning

confidence: 45%

“…It has been reported that the mortality rates can be as high as 40-50% in patients with CRKP infections (Patel et al, 2008). The pathogens often harbor multiple drug-resistant genes that cause the bacteria hetero-resistance to antibiotics in addition to β-bactams (Band et al, 2018(Band et al, , 2019, severely limiting alternative treatment options and increasing therapeutic cost (Huang et al, 2018;Santos and Secoli, 2019). The development of new antimicrobial agents to combat new CRKP isolates is extremely time-consuming, and therapeutic replacement with novel alternative agents may cause potential toxicities.…”

Section: Introductionmentioning

confidence: 99%

Synergetic Effects of Combined Treatment of Colistin With Meropenem or Amikacin on Carbapenem-Resistant Klebsiella pneumoniae in vitro

Zhang

et al. 2019

Front. Cell. Infect. Microbiol.

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The purpose of this study was to investigate the synergistic and bactericidal effects of combinations of colistin with meropenem or amikacin in vitro and provide laboratory data needed for development of therapeutic strategies for the treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection. We found that minimum inhibitory concentration (MIC) of colistin, meropenem and amikacin were 2∼32, 4∼256, and 1∼16384 µg/ml, respectively. The minimum bactericidal concentration of the antibiotics was either 1× or 2×MIC. Treatments of 6 CRKP isolates at 1 µg/ml colistin completely killed 2 of them and suppressed 4 others growth. 4 CRKP isolates at 16 µg/ml meropenem or amikacin completely killed and suppressed 2 others growth. 2 CRKP isolates showed synergic effects in all colistin combination and 3 CRKP isolates showed synergic effects in part of colistin combination. Our data suggest that colistin in combination with either meropenem or amikacin could be a valid therapeutic option against colistin-resistant CRKP isolates. Moreover, the combination of colistin-amikacin is less expensive to treat CRKP infections in Eastern Heilongjiang Province.

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“…Therefore, it is important to select variables in the PSM analysis. Some variables representing the severity of illness, including whether admitted to the ICU, whether undergoing surgery, complications or underlying disease, were included in the PSM analyses to decrease the influence of these variables on the main indicators; however, we excluded some variables that were directly related to hospital costs, such as length of hospital stay, length of ICU stay, and number of surgeries 44 , which is consistent with some studies 13,48 . Some caution should be taken in the interpretation of these results.…”

Section: Discussionmentioning

confidence: 95%

Clinical and economic impact of methicillin-resistant Staphylococcus aureus: a multicentre study in China

Zhen

Lundborg

Zhang

et al. 2020

Sci Rep

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Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to global health.In China, the proportion of S. aureus isolates that were MRSA was 44.6% in 2014. The clinical and economic impact of MRSA in China remains largely uninvestigated. This study aims to compare the differences in hospital costs, length of hospital stay, and hospital mortality rate between MRSA and methicillin-susceptible S. aureus (MSSA) colonization or infection and between MRSA cases and those without an S. aureus infection. A retrospective and multicentre study was conducted in four tertiary hospitals in China between 2013 and 2015. Inpatient characteristics and hospital costs were collected from electronic medical records. We conducted propensity score matching (PSM) to eliminate selection bias by balancing the potential confounding variables between the two groups. The main indicators included hospital costs, length of hospital stay, and hospital mortality rate. A total of 1,335 inpatients with MRSA, 1,397 with MSSA, and 33,606 without an S. aureus infection were included. PSM obtained 954 and 1,313 pairs between the MRSA and MSSA groups and between the MRSA and S. aureus-free groups, respectively. After PSM, MRSA colonization or infection is associated with an increased total hospital cost ranging from $3,220 to $9,606, an excess length of hospital stay of 6 days-14 days, and an attributable hospital mortality rate of 0-3.58%. Between the MRSA and MSSA groups, MRSA colonization or infection was significantly associated with a higher total hospital cost and longer length of hospital stay among survivors but not among non-survivors; however, there were no differences in the hospital mortality rate between these two groups. Between the MRSA and the S. aureus-free groups, MRSA colonization or infection was significantly associated with an increased total hospital cost, a prolonged length of hospital stay and a higher hospital mortality rate among both survivors and non-survivors. It is critical to quantify the clinical and economic impact of MRSA to justify resource allocation for the development of strategies to improve clinical outcomes and to reduce the economic burden.Staphylococcus aureus is an important gram-positive bacterium in both community-and health-care-associated infections and can be resistant or susceptible to the usual antibiotics used to treat it (oxacillin or cefoxitin), namely, methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA), respectively 1,2 . MRSA has become a serious threat to global health and is responsible for a range of infections, from skin and wound infections to pneumonia and bloodstream infections. It is commonly associated with significant morbidity, hospital mortality, length of stay and economic burden 1 . In all World Health Organization (WHO) regions, the overall proportion of S. aureus isolates that were MRSA exceeded 20% and even exceeded 80% in some reports 3 . In China, there was a marked decrease in the proportion of MRSA from 69% in 2005 to 44.6...

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In-hospital Medical Costs of Infections Caused by Carbapenem-resistantKlebsiella pneumoniae

Cited by 53 publications

References 15 publications

Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Synergetic Effects of Combined Treatment of Colistin With Meropenem or Amikacin on Carbapenem-Resistant Klebsiella pneumoniae in vitro

Clinical and economic impact of methicillin-resistant Staphylococcus aureus: a multicentre study in China

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