title: Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital.
abstract: The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital.
  
  
  
  We conducted a retrospective, matched case-control-control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection.
  
  
  
  Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26-12.42), tracheostomy (OR:2.24; 95%CI: 1.14-4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31-28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52-95.4), urinary system disease (OR: 16.69; 95%CI: 3.01-89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46-5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89-26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01).
  
  
  
  Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Meng
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Sidi
authors.initials: S
authors.lastname: Liu
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Juping
authors.initials: J
authors.lastname: Duan
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Huang
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Zhou
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Xinrui
authors.initials: X
authors.lastname: Xiong
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Ruie
authors.initials: R
authors.lastname: Gong
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China.
authors.forename: Chenchao
authors.initials: C
authors.lastname: Fu
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China. lichunhui@csu.edu.cn.
authors.forename: Chunhui
authors.initials: C
authors.lastname: Li
authors.affiliation: Infection Control Centre, Xiangya Hospital of Central South University, Changsha, China. xywuanhua@csu.edu.cn.
authors.forename: Anhua
authors.initials: A
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents; D015780:Carbapenems; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D017048:Health Care Costs; D006454:Hemoglobins; D006784:Hospitals, Teaching; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014139:Tracheostomy / Q000706:statistics & numerical data; D014570:Urologic Diseases / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015780:Carbapenems; D006454:Hemoglobins
keywords: CREC; CSEC; Healthcare-associated infection; Risk factors