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.
authors: Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors: Andrew J
authors: AJ
authors: Stewardson
authors: Arthur
authors: A
authors: Allignol
authors: Jan
authors: J
authors: Beyersmann
authors: Nicholas
authors: N
authors: Graves
authors: Martin
authors: M
authors: Schumacher
authors: Rodolphe
authors: R
authors: Meyer
authors: Evelina
authors: E
authors: Tacconelli
authors: Giulia
authors: G
authors: De Angelis
authors: Claudio
authors: C
authors: Farina
authors: Fabio
authors: F
authors: Pezzoli
authors: Xavier
authors: X
authors: Bertrand
authors: Houssein
authors: H
authors: Gbaguidi-Haore
authors: Jonathan
authors: J
authors: Edgeworth
authors: Olga
authors: O
authors: Tosas
authors: Jose A
authors: JA
authors: Martinez
authors: M Pilar
authors: MP
authors: Ayala-Blanco
authors: Angelo
authors: A
authors: Pan
authors: Alessia
authors: A
authors: Zoncada
authors: Charis A
authors: CA
authors: Marwick
authors: Dilip
authors: D
authors: Nathwani
authors: Harald
authors: H
authors: Seifert
authors: Nina
authors: N
authors: Hos
authors: Stefan
authors: S
authors: Hagel
authors: Mathias
authors: M
authors: Pletz
authors: Stephan
authors: S
authors: Harbarth
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018550:Cephalosporin Resistance; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000191:economics / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000191:economics / Q000401:mortality*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Escherichia coli; Meticillin-resistant Staphylococcus aureus (MRSA) in humans; Staphylococcus aureus; bacterial infections; bloodstream infection; multidrug resistance