title: Clinical and economic outcomes associated with community-acquired intra-abdominal infections caused by extended spectrum beta-lactamase (ESBL) producing bacteria in China.
abstract: BACKGROUND
  To compare clinical and economic outcomes in patients with community-acquired intra-abdominal infection (IAI) due to extended spectrum beta-lactamase (ESBL) producing (ESBL-positive) bacteria versus non-ESBL-producing (ESBL-negative) bacteria in China.
  
  
  METHODS
  This was a retrospective chart review study of patients hospitalized with community-acquired IAI due to ESBL-positive or ESBL-negative infections caused by Escherichia coli or Klebsiella spp. Data were collected from six hospitals in China that participated in the Study for Monitoring Antibiotic Resistance Trends (SMART) during 2006-2007. Outcomes included clinical response at discharge and following first-line antibiotic, number of antibiotic agents and classes, duration of hospitalization, and overall hospitalization and intravenous antibiotic costs.
  
  
  RESULTS
  Of the 85 patients included in the study, 32 (37.6%) had ESBL-positive and 53 (62.4%) had ESBL-negative infections; E. coli was responsible for 77.6% of infections. Infection resolved at discharge in 30 (93.8%) ESBL-positive and 48 (90.6%) ESBL-negative patients (P = NS). Fewer ESBL-positive patients achieved complete response following first-line antibiotics (56.3% versus 83.0%; P = 0.01). ESBL-positive patients required longer antibiotic treatment, more antibiotics, longer hospitalization (24.3 versus 14.6 days; 1.67-fold ratio; P = 0.001), and incurred higher hospitalization costs ( yen24,604 vs. yen13,788; $3604 vs. $2020; 1.78-fold ratio; P < 0.001).
  
  
  CONCLUSIONS
  Patients with ESBL-positive infection had similar resolution rates at discharge compared to those with ESBL-negative infection, despite poorer first-line antibiotic response. However, ESBL-positive infection led to significantly greater hospitalization cost and intravenous antibiotic cost, and longer hospital stay.
authors.affiliation: Department of Infectious Diseases, Zhongshan Hospital of Fu Dan University, Shanghai, China.
authors.forename: Bijie
authors.initials: B
authors.lastname: Hu
authors.forename: Huifeng
authors.initials: H
authors.lastname: Ye
authors.forename: Yingchun
authors.initials: Y
authors.lastname: Xu
authors.forename: Yuxing
authors.initials: Y
authors.lastname: Ni
authors.forename: Yunjian
authors.initials: Y
authors.lastname: Hu
authors.forename: Yunsong
authors.initials: Y
authors.lastname: Yu
authors.forename: Zhenfei
authors.initials: Z
authors.lastname: Huang
authors.forename: Larry
authors.initials: L
authors.lastname: Ma
mesh_terms: D000005:Abdomen / Q000382:microbiology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D002681:China; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics*; D003365:Costs and Cost Analysis; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000201:enzymology; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000187:drug effects / Q000201:enzymology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000201:enzymology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases