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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

2016; European Centre for Disease Prevention and Control; Volume: 21; Issue: 33 Linguagem: Inglês

10.2807/1560-7917.es.2016.21.33.30319

1560-7917

Andrew J. Stewardson, Arthur Allignol, Jan Beyersmann, Nicholas Graves, Martin Schumacher, Rodolphe Meyer, Evelina Tacconelli, Giulia De Angelis, Claudio Farina, Fabio Pezzoli, Xavier Bertrand, Houssein Gbaguidi‐Haore, Jonathan D. Edgeworth, Olga Tosas, José Antônio Baddini Martínez, M Pilar Ayala-Blanco, Angelo Pan, Alessia Zoncada, Charis Marwick, Dilip Nathwani, Harald Seifert, Nina Judith Hos, Stefan Hagel, Mathias W. Pletz, Stephan Harbarth,

Urinary Tract Infections Management

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.