The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study

Abstract

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

Estimation of adjusted expected excess length‐of‐stay associated with ventilation‐acquired pneumonia in intensive care: A multistate approach accounting for time‐dependent mechanical ventilation

“…Second, the vast majority of patients is typically discharged alive from the ICU in studies on hospital‐acquired infection even though mortality in our study (in the data example below: approximately 25%) is higher as, for example, in the study of Stewardson et al. ().…”

“…This concept of expected excess LoS has been successfully applied in numerous studies (cf. Allignol, Schumacher, & Beyersmann, ; De Angelis et al., ; de Kraker et al., ; Macedo‐Vinas et al., ; Stewardson et al., ; Van Kleef et al., ; Wolkewitz, von Cube, & Schumacher, , for recent examples).…”

“…Stewardson et al. () applied this technique to model the impact of baseline confounding on the expected excess LoS associated with nosocomial infection, but properties have not been investigated. A methodological work based on the more general illness‐death model with recovery combining the concept of pseudovalues with landmarking has recently been published by Grand and Putter (); however, they have considered the expected LoS in a given state of a multistate model, but not the expected excess LoS (here: in ICU) as the main quantity of interest.…”

Satellite tracking of gulls and genomic characterization of faecal bacteria reveals environmentally mediated acquisition and dispersal of antimicrobial‐resistant Escherichia coli on the Kenai Peninsula, Alaska

“…Although AMR is not a new phenomenon, its prevalence in many clinically important bacterial pathogens is increasing (Gelband et al, ; Nordmann, Poirel, Walsh, & Livermore, ). Multidrug‐resistant (MDR) Enterobacteriaceae, in particular, present substantial health and economic burdens (Alvarez‐Uria, Gandra, Mandal, & Laxminarayan, ; Stewardson et al, ). The proliferation of these bacteria, including MDR Escherichia coli , has been largely attributed to the horizontal acquisition of AMR genes (Leverstein‐van Hall et al, ; San Millan, ), a mechanism that may occur in both clinical and nonclinical settings (Dolejska & Papagiannitsis, ).…”

Patient engagement with surgical site infection prevention: an expert panel perspective

“…Thus emphasizing the importance of surveillance and adherence to infection prevention and control policies for these patients [52, 53]. Of note, admission screening of patients at high risk of MDRO carriage (e.g.…”