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 J Stewardson, A Allignol, J Beyersmann, N Graves, M Schumacher, R Meyer, E Tacconelli, G De Angelis, C Farina, F Pezzoli, X Bertrand, H Gbaguidi-Haore, J Edgeworth, O Tosas, J A Martinez, M P Ayala-Blanco, A Pan, A Zoncada, C A Marwick, D Nathwani & 1 others the TIMBER Study Group

Research output: Contribution to journalArticleResearchpeer-review

52 Citations (Scopus)

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.
Original languageEnglish
Article number30319
Number of pages12
JournalEurosurveillance
Volume21
Issue number33
DOIs
Publication statusPublished - 18 Aug 2016
Externally publishedYes

Keywords

  • Antimicrobial resistance
  • bacterial infections
  • bloodstream infection
  • Escherichia coli
  • Meticillin-resistant Staphylococcus aureus (MRSA) in humans
  • multidrug resistance
  • Staphylococcus aureus

Cite this

Stewardson, A J ; Allignol, A ; Beyersmann, J ; Graves, N ; Schumacher, M ; Meyer, R ; Tacconelli, E ; De Angelis, G ; Farina, C ; Pezzoli, F ; Bertrand, X ; Gbaguidi-Haore, H ; Edgeworth, J ; Tosas, O ; Martinez, J A ; Ayala-Blanco, M P ; Pan, A ; Zoncada, A ; Marwick, C A ; Nathwani, D ; the TIMBER Study Group. / 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. In: Eurosurveillance. 2016 ; Vol. 21, No. 33.
@article{1f87fe6ec9b74af3938f6042dbc5427a,
title = "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.",
keywords = "Antimicrobial resistance, bacterial infections, bloodstream infection, Escherichia coli, Meticillin-resistant Staphylococcus aureus (MRSA) in humans, multidrug resistance, Staphylococcus aureus",
author = "Stewardson, {A J} and A Allignol and J Beyersmann and N Graves and M Schumacher and R Meyer and E Tacconelli and {De Angelis}, G and C Farina and F Pezzoli and X Bertrand and H Gbaguidi-Haore and J Edgeworth and O Tosas and Martinez, {J A} and Ayala-Blanco, {M P} and A Pan and A Zoncada and Marwick, {C A} and D Nathwani and {the TIMBER Study Group}",
year = "2016",
month = "8",
day = "18",
doi = "10.2807/1560-7917.ES.2016.21.33.30319",
language = "English",
volume = "21",
journal = "Eurosurveillance",
issn = "1025-496X",
publisher = "European Centre for Disease Prevention and Control",
number = "33",

}

Stewardson, AJ, Allignol, A, Beyersmann, J, Graves, N, Schumacher, M, Meyer, R, Tacconelli, E, De Angelis, G, Farina, C, Pezzoli, F, Bertrand, X, Gbaguidi-Haore, H, Edgeworth, J, Tosas, O, Martinez, JA, Ayala-Blanco, MP, Pan, A, Zoncada, A, Marwick, CA, Nathwani, D & the TIMBER Study Group 2016, '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', Eurosurveillance, vol. 21, no. 33, 30319. https://doi.org/10.2807/1560-7917.ES.2016.21.33.30319

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. / Stewardson, A J; Allignol, A; Beyersmann, J; Graves, N; Schumacher, M; Meyer, R; Tacconelli, E; De Angelis, G; Farina, C; Pezzoli, F; Bertrand, X; Gbaguidi-Haore, H; Edgeworth, J; Tosas, O; Martinez, J A; Ayala-Blanco, M P; Pan, A; Zoncada, A; Marwick, C A; Nathwani, D; the TIMBER Study Group.

In: Eurosurveillance, Vol. 21, No. 33, 30319, 18.08.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - 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

T2 - a multicentre retrospective cohort study

AU - Stewardson, A J

AU - Allignol, A

AU - Beyersmann, J

AU - Graves, N

AU - Schumacher, M

AU - Meyer, R

AU - Tacconelli, E

AU - De Angelis, G

AU - Farina, C

AU - Pezzoli, F

AU - Bertrand, X

AU - Gbaguidi-Haore, H

AU - Edgeworth, J

AU - Tosas, O

AU - Martinez, J A

AU - Ayala-Blanco, M P

AU - Pan, A

AU - Zoncada, A

AU - Marwick, C A

AU - Nathwani, D

AU - the TIMBER Study Group

PY - 2016/8/18

Y1 - 2016/8/18

N2 - 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.

AB - 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.

KW - Antimicrobial resistance

KW - bacterial infections

KW - bloodstream infection

KW - Escherichia coli

KW - Meticillin-resistant Staphylococcus aureus (MRSA) in humans

KW - multidrug resistance

KW - Staphylococcus aureus

UR - http://www.scopus.com/inward/record.url?scp=85014995906&partnerID=8YFLogxK

U2 - 10.2807/1560-7917.ES.2016.21.33.30319

DO - 10.2807/1560-7917.ES.2016.21.33.30319

M3 - Article

VL - 21

JO - Eurosurveillance

JF - Eurosurveillance

SN - 1025-496X

IS - 33

M1 - 30319

ER -