Burden of Bloodstream Infection Caused by Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

Autor: Peter Rohner, Andrew J. Stewardson, Giulia De Angelis, Carolina Fankhauser, Didier Pittet, Stéphan Juergen Harbarth, Edith Safran, Jacques Schrenzel
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Microbiology (medical)
Male
Pediatrics
medicine.medical_specialty
Cross Infection/economics/epidemiology/microbiology
Epidemiology
Enterobacteriaceae Infections/economics/epidemiology/microbiology
Length of hospitalization
Bacteremia
beta-Lactamases
Hospitals
University
Cost of Illness
Enterobacteriaceae
Bloodstream infection
Internal medicine
medicine
Confidence Intervals
polycyclic compounds
Humans
Sex Distribution
Beta-Lactamases/biosynthesis
Length of Stay/economics/statistics & numerical data
Aged
Proportional Hazards Models
Retrospective Studies
ddc:616
Cross Infection
Proportional hazards model
business.industry
Hazard ratio
Enterobacteriaceae Infections
Length of Stay
Middle Aged
Models
Theoretical
biochemical phenomena
metabolism
and nutrition
University hospital
bacterial infections and mycoses
Confidence interval
3. Good health
Infectious Diseases
Enterobacteriaceae/enzymology/isolation & purification
Bacteremia/economics/microbiology
Cohort
Female
business
Switzerland
Forecasting
Zdroj: Infection Control & Hospital Epidemiology; Vol 34
Infection Control and Hospital Epidemiology, Vol. 34, No 2 (2013) pp. 133-43
ISSN: 0899-823X
0195-9417
DOI: 10.1086/669086
Popis: Objective.To obtain an unbiased estimate of the excess hospital length of stay (LOS) and cost attributable to extended-spectrum β-lactamase (ESBL) positivity in bloodstream infections (BSIs) due to Enterobacteriaceae.Design.Retrospective cohort study.Setting.A 2,200-bed academic medical center in Geneva, Switzerland.Patients.Patients admitted during 2009.Methods.We used multistate modeling and Cox proportional hazards models to determine the excess LOS and adjusted end-of-LOS hazard ratio (HR) for ESBL-positive and ESBL-negative BSI. We estimated economic burden as the product of excess LOS and average bed-day cost. Patient-level accounting data provided a complementary analysis of economic burden. A predictive model was fitted to national surveillance data.Results.Thirty ESBL-positive and 96 ESBL-negative BSI cases were included. The excess LOS attributable to ESBL-positive and ESBL-negative BSI was 9.4 (95% confidence interval [CI], 0.4–18.4) and 2.6 (95% CI, 0.7–5.9) days, respectively. ESBL positivity was therefore associated with 6.8 excess days and CHF 9,473 per BSI. The adjusted end-of-LOS HRs for ESBL-positive and ESBL-negative BSI were 0.62 (95% CI, 0.43–0.89) and 0.90 (95% CI, 0.74–1.10), respectively. After reimbursement, the average financial loss per acute care episode in ESBL-positive BSI, ESBL-negative BSI, and control cohorts was CHF 48,674, 48,131, and 13,532, respectively. Our predictive model estimated that the nationwide cost of third-generation cephalosporin resistance would increase from CHF 2,084,000 in 2010 to CHF 3,526,000 in 2015.Conclusions.This is the first hospital-wide analysis of excess LOS attributable to ESBL positivity determined using multistate modeling to avoid time-dependent bias. These results may inform health-economic evaluations of interventions targeting ESBL control.
Databáze: OpenAIRE
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