title: Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species.
abstract: BACKGROUND
  This study evaluated the clinical and economic impact of the emergence of third-generation cephalosporin-resistant Enterobacter species.
  
  
  METHODS
  Mortality, length of hospitalization, and hospital charges were examined in a cohort that was selected from a group of 477 patients with initial cultures that yielded a third-generation cephalosporin-susceptible Enterobacter species. Case patients (n = 46) had subsequent cultures yielding a third-generation cephalosporin-resistant Enterobacter species. Control patients (n = 113) who did not develop resistance were matched to cases on site of Enterobacter infection and length of hospitalization prior to isolation of the initial susceptible organism. Multivariable analyses were used to adjust for confounding.
  
  
  RESULTS
  Twenty-six percent of cases died vs 13% of controls (P =.06). The median total hospital stay for cases was 29.5 days (interquartile range [IQR], 20-60) and 19 days for controls (IQR, 13-27; P<.001). The median hospital charge for cases was $79 323 (IQR, $34 546-$161 384) and for controls was $40 406 (IQR, $18 470-$79 005; P<.001). After adjusting for comorbidities, severity of illness, intensive care unit admission, surgery, transfer from another hospital, sex, and age, emergence of resistance was associated with increased mortality (relative risk, 5.02; P =.01), hospital stay (1.5-fold, P<.001), and hospital charges (1.5-fold, P<.001). Emergence of resistance had a median attributable hospital stay of 9 days and an average attributable hospital charge of $29 379.
  
  
  CONCLUSIONS
  Emergence of antibiotic resistance in Enterobacter species results in increased mortality, hospital stay, and hospital charges. Minimizing resistance in Enterobacter species should be a priority.
authors.affiliation: Department of Medicine, The John Hopkins Hospital, 1830 E Monument St, Room 9020, Baltimore, MD 21287, USA. scosgro1@jhmi.edu
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: George M
authors.initials: GM
authors.lastname: Eliopoulous
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000368:Aged; D018550:Cephalosporin Resistance; D003428:Cross Infection / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D004754:Enterobacter / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D014481:United States