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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
2025-07-14
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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 Sept 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 20 Apr 2016 </span> </p>
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