Excess burden of antibiotic-resistant bloodstream infections: evidence from a multicentre retrospective cohort study in Chile, 2018–2022

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2024-11-12 DOI:10.1016/j.lana.2024.100943

Kasim Allel , Anne Peters , Hassan Haghparast-Bidgoli , Maria Spencer-Sandino , Jose Conejeros , Patricia Garcia , Koen B. Pouwels , Laith Yakob , Jose M. Munita , Eduardo A. Undurraga

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引用次数: 0

Abstract

Background

Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria.

Methods

We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by Acinetobacter baumannii, Enterobacterales, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs.

Findings

We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were Staphylococcus aureus (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and Pseudomonas aeruginosa (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at $12,600 per patient, with an estimated annual excess burden of 2270 disability-adjusted life years (DALYs) and $9.6 (5.0–16.4) million.

Interpretation

It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE.

Funding

Agencia Nacional de Investigación y Desarrollo ANID, Chile.

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耐抗生素血流感染负担过重：2018-2022年智利多中心回顾性队列研究的证据

背景耐抗生素血流感染（ARB BSI）造成了巨大的疾病和经济负担。与易感细菌引起的 BSI 相比，我们评估了高优先级和关键优先级病原体引起的 ARB BSI 对智利住院患者的影响。方法我们于 2018 年至 2022 年在三家智利医院开展了一项回顾性队列研究，并测量了 ARB BSI 与院内死亡率、住院时间（LOS）和重症监护病房（ICU）入院率之间的关联。我们重点研究了鲍曼不动杆菌、肠杆菌、金黄色葡萄球菌、肠球菌和铜绿假单胞菌引起的 BSI。我们采用倾向评分、反概率加权和多元回归等方法解决了混杂问题。我们根据社区和医院获得性 BSI 进行了分层，并评估了医院和生产成本总额。主要病原体为金黄色葡萄球菌（33% 为耐甲氧西林 MRSA）、肠杆菌科细菌（50% 为耐碳青霉烯类 CRE）和铜绿假单胞菌（65% 为耐碳青霉烯类 CRPA）。约 80% 的 BSI 为医院获得性感染。在所有 BSI 病例中，ARB 与指数血培养后住院时间延长（发病风险比 IRR = 1.14，95% CI = 1.05-1.24）、ICU 入院率增加（几率比 OR = 1.25；1.07-1.46）和死亡率升高（OR = 1.42，1.20-1.68）有关。经时变和固定混杂因素调整后，ARB 患者的院内死亡风险高出 1.35 倍（1.16-1.58），医院获得性 MRSA 和 CRE 的危险比分别为 1.37 和 1.48。从社会角度和5%的贴现率来看，我们估计ARB的超额成本为每位患者12,600美元，估计每年的超额负担为2270个残疾调整生命年（DALYs）和960万美元（5.0-16.4）。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.