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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  (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  had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

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2016-08-18
2019-10-15
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.33.30319
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References

  1. World Health Organization (WHO). Antimicrobial resistance: global report on surveillance 2014. Geneva: WHO Press, 2014. Available from: http://www.who.int/drugresistance/documents/surveillancereport/en/
  2. Risks G. 2014. 9th edition. Geneva: World Economic Forum; 2014. Available from: http://reports.weforum.org/global-risks-2014/
  3. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057-98.  https://doi.org/10.1016/S1473-3099(13)70318-9  PMID: 24252483 
  4. Beyersmann J, Wolkewitz M, Allignol A, Grambauer N, Schumacher M. Application of multistate models in hospital epidemiology: advances and challenges. Biom J. 2011;53(2):332-50.  https://doi.org/10.1002/bimj.201000146  PMID: 21374697 
  5. Gandra S, Barter DM, Laxminarayan R. Economic burden of antibiotic resistance: how much do we really know? Clin Microbiol Infect. 2014;20(10):973-80.  https://doi.org/10.1111/1469-0691.12798  PMID: 25273968 
  6. Graves N, Harbarth S, Beyersmann J, Barnett A, Halton K, Cooper B. Estimating the cost of health care-associated infections: mind your p’s and q’s. Clin Infect Dis. 2010;50(7):1017-21.  https://doi.org/10.1086/651110  PMID: 20178419 
  7. Woerther PL, Burdet C, Chachaty E, Andremont A. Trends in human fecal carriage of extended-spectrum β-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev. 2013;26(4):744-58.  https://doi.org/10.1128/CMR.00023-13  PMID: 24092853 
  8. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7.  https://doi.org/10.1016/S0140-6736(07)61602-X  PMID: 18064739 
  9. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.  https://doi.org/10.1016/0021-9681(87)90171-8  PMID: 3558716 
  10. Cohen AL, Calfee D, Fridkin SK, Huang SS, Jernigan JA, Lautenbach E, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC Position paper. Infect Control Hosp Epidemiol. 2008;29(10):901-13.  https://doi.org/10.1086/591741  PMID: 18808340 
  11. Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-9.  https://doi.org/10.1097/01.mlr.0000182534.19832.83  PMID: 16224307 
  12. Stewardson A, Fankhauser C, De Angelis G, Rohner P, Safran E, Schrenzel J, et al. Burden of bloodstream infection caused by extended-spectrum β-lactamase-producing enterobacteriaceae determined using multistate modeling at a Swiss University Hospital and a nationwide predictive model. Infect Control Hosp Epidemiol. 2013;34(2):133-43.  https://doi.org/10.1086/669086  PMID: 23295559 
  13. Aalen O, Johansen S. An empirical transition matrix for non-homogeneous Markov chains based on censored observations. Scand J Stat. 1978;5:141-50.
  14. Andersen PK, Perme MP. Pseudo-observations in survival analysis. Stat Methods Med Res. 2010;19(1):71-99.  https://doi.org/10.1177/0962280209105020  PMID: 19654170 
  15. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73(1):13-22.  https://doi.org/10.1093/biomet/73.1.13 
  16. Lunn D, Jackson C, Best N, Thomas A, Spiegelhalter D. The BUGS Book: A practical introduction to Bayesian Analysis. London: CRC Press / Chapman and Hall, 2012.
  17. Stewardson AJ, Harbarth S, Graves NTIMBER Study Group. Valuation of hospital bed-days released by infection control programs: a comparison of methods. Infect Control Hosp Epidemiol. 2014;35(10):1294-7.  https://doi.org/10.1086/678063  PMID: 25203185 
  18. Beyersmann J, Allignol A, Schumacher M. Competing risks and multistate models with R. Berlin: Springer, 2012.
  19. Beyersmann J, Gastmeier P, Schumacher M. Incidence in ICU populations: how to measure and report it? Intensive Care Med. 2014;40(6):871-6.  https://doi.org/10.1007/s00134-014-3279-7  PMID: 24817028 
  20. Beyersmann J, Gastmeier P, Grundmann H, Bärwolff S, Geffers C, Behnke M, et al. Transmission-associated nosocomial infections: prolongation of intensive care unit stay and risk factor analysis using multistate models. Am J Infect Control. 2008;36(2):98-103.  https://doi.org/10.1016/j.ajic.2007.06.007  PMID: 18313511 
  21. Graves N. Economics and preventing hospital-acquired infection. Emerg Infect Dis. 2004;10(4):561-6.  https://doi.org/10.3201/eid1004.020754  PMID: 15200842 
  22. de Kraker ME, Wolkewitz M, Davey PG, Grundmann HBURDEN Study Group. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother. 2011;55(4):1598-605.  https://doi.org/10.1128/AAC.01157-10  PMID: 21220533 
  23. de Kraker ME, Wolkewitz M, Davey PG, Koller W, Berger J, Nagler J, et al. Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother. 2011;66(2):398-407.  https://doi.org/10.1093/jac/dkq412  PMID: 21106563 
  24. Lambert ML, Suetens C, Savey A, Palomar M, Hiesmayr M, Morales I, et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect Dis. 2011;11(1):30-8.  https://doi.org/10.1016/S1473-3099(10)70258-9  PMID: 21126917 
  25. Kieszak SM, Flanders WD, Kosinski AS, Shipp CC, Karp H. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol. 1999;52(2):137-42.  https://doi.org/10.1016/S0895-4356(98)00154-1  PMID: 10201654 
  26. Luthi JC, Troillet N, Eisenring MC, Sax H, Burnand B, Quan H, et al. Administrative data outperformed single-day chart review for comorbidity measure. Int J Qual Health Care. 2007;19(4):225-31.  https://doi.org/10.1093/intqhc/mzm017  PMID: 17599922 
  27. Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother. 2012;67(6):1311-20.  https://doi.org/10.1093/jac/dks065  PMID: 22396430 
  28. Leibovici L. Long-term consequences of severe infections. Clin Microbiol Infect. 2013;19(6):510-2.  https://doi.org/10.1111/1469-0691.12160  PMID: 23397980 
  29. Smith R, Coast J. The true cost of antimicrobial resistance. BMJ. 2013;346:f1493.  https://doi.org/10.1136/bmj.f1493  PMID: 23479660 
  30. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. London; 2014. Available from: https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf
  31. de Kraker ME, Jarlier V, Monen JC, Heuer OE, van de Sande N, Grundmann H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect. 2013;19(9):860-8.  https://doi.org/10.1111/1469-0691.12028  PMID: 23039210 
  32. Ammerlaan HS, Harbarth S, Buiting AG, Crook DW, Fitzpatrick F, Hanberger H, et al. Secular trends in nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection. Clin Infect Dis. 2013;56(6):798-805.  https://doi.org/10.1093/cid/cis1006  PMID: 23223600 
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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Andrew+J+Stewardson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stewardson Andrew J</a>, <a href="/search?value1=Arthur+Allignol&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Allignol Arthur</a>, <a href="/search?value1=Jan+Beyersmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beyersmann Jan</a>, <a href="/search?value1=Nicholas+Graves&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Graves Nicholas</a>, <a href="/search?value1=Martin+Schumacher&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schumacher Martin</a>, <a href="/search?value1=Rodolphe+Meyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meyer Rodolphe</a>, <a href="/search?value1=Evelina+Tacconelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tacconelli Evelina</a>, <a href="/search?value1=Giulia+De+Angelis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">De Angelis Giulia</a>, <a href="/search?value1=Claudio+Farina&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Farina Claudio</a>, <a href="/search?value1=Fabio+Pezzoli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pezzoli Fabio</a>, <a href="/search?value1=Xavier+Bertrand&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bertrand Xavier</a>, <a href="/search?value1=Houssein+Gbaguidi-Haore&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gbaguidi-Haore Houssein</a>, <a href="/search?value1=Jonathan+Edgeworth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Edgeworth Jonathan</a>, <a href="/search?value1=Olga+Tosas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tosas Olga</a>, <a href="/search?value1=Jose+A+Martinez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martinez Jose A</a>, <a href="/search?value1=M+Pilar+Ayala-Blanco&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ayala-Blanco M Pilar</a>, <a href="/search?value1=Angelo+Pan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pan Angelo</a>, <a href="/search?value1=Alessia+Zoncada&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zoncada Alessia</a>, <a href="/search?value1=Charis+A+Marwick&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marwick Charis A</a>, <a href="/search?value1=Dilip+Nathwani&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nathwani Dilip</a>, <a href="/search?value1=Harald+Seifert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Seifert Harald</a>, <a href="/search?value1=Nina+Hos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hos Nina</a>, <a href="/search?value1=Stefan+Hagel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hagel Stefan</a>, <a href="/search?value1=Mathias+Pletz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pletz Mathias</a>, <a href="/search?value1=Stephan+Harbarth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Harbarth Stephan</a>, <a href="/search?value1=the+TIMBER+Study+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the TIMBER Study Group</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(33):pii=30319. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.33.30319" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.33.30319</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 23 Sep 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 20 Apr 2016 </span> </p>
/content/10.2807/1560-7917.ES.2016.21.33.30319
/content/10.2807/1560-7917.ES.2016.21.33.30319
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