Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-24T01:08:30.225Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella Species on Clinical Outcomes and Hospital Costs: A Matched Cohort Study

Published online by Cambridge University Press:  21 June 2016

Su Young Lee ,
Srividya Kotapati ,
Joseph L. Kuti ,
Charles H. Nightingale  and
David P. Nicolau
Su Young Lee
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
Srividya Kotapati
Affiliation:
University of Massachusetts Medical School, Worcester, Massachusetts
Joseph L. Kuti
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
Charles H. Nightingale
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
David P. Nicolau*
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
*
Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102 (dnicola@harthosp.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives.

To evaluate the economic and clinical impact of infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK).

Design.

A matched-cohort analysis of the cost of illness.

Setting.

An 810-bed, urban, community hospital in Hartford, Connecticut.

Patients.

Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non–ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received.

Results.

Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P = .034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days] P = .006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P = .027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P = .013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen.

Conclusion.

The cost of non–urinary tract infections caused by ESBL-EK was 1.7 times the cost of non–urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1226 - 1232
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Jacoby, GA, Munoz-Price, LS. The new beta-lactamases. N Engl J Med 2005; 352:380–391.Google Scholar
2. Thomson, KS, Smith Moland, E. Version 2000: the new beta-lactamases of gram-negative bacteria at the dawn of the new millennium. Microbes Infect 2000; 2:1225–1235.Google Scholar
3. Vahaboglu, H, Ozturk, R, Aygun, G, et al. Widespread detection of PER-1-type extended-spectrum beta-lactamases among nosocomial Acineto-bacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicenter study. Antimicrob Agents Chemother 1997; 41:2265–2269.CrossRefGoogle Scholar
4. Joshi, SG, Litake, GM, Ghole, VS, Niphadkar, KB. Plasmid-borne extended-spectrum beta-lactamase in a clinical isolate of Acinetobacter baumannii . J Med Microbiol 2003; 52:1125–1127.Google Scholar
5. Livermore, DM. Beta-lactamase–mediated resistance and opportunities for its control. J Antimicrob Chemother 1998; 41(Suppl D):25–41.Google Scholar
6. Winokur, PL, Canton, R, Casellas, JM, Legakis, N. Variations in the prevalence of strains expressing an extended-spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific region. Clin Infect Dis 2001; 32(Suppl 2):S94–S103.Google Scholar
7. Dandekar, PK, Tetreault, J, Quinn, JP, Nightingale, CH, Nicolau, DP. Prevalence of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella isolates in a large community teaching hospital in Connecticut. Diagn Microbiol Infect Dis 2004; 49:37–39.CrossRefGoogle Scholar
8. Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001; 32:1162–1171.Google Scholar
9. Lautenbach, E, Strom, BL, Bilker, WB, Patel, JB, Edelstein, PH, Fishman, NO. Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae . Clin Infect Dis 2001; 33:1288–1294.Google Scholar
10. Wong-Beringer, A, Hindler, J, Loeloff, M, et al. Molecular correlation for the treatment outcomes in bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae with reduced susceptibility to ceftazidime. Clin Infect Dis 2002; 34:135–146.CrossRefGoogle ScholarPubMed
11. Wong-Beringer, A. Therapeutic challenges associated with extended-spectrum, beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae . Pharmacotherapy 2001; 21:583–592.CrossRefGoogle ScholarPubMed
12. Zanetti, G, Bally, F, Greub, G, et al. Cefepime versus imipenem-cilastatin for treatment of nosocomial pneumonia in intensive care unit patients: a multicenter, evaluator-blind, prospective, randomized study. Antimicrob Agents Chemother 2003; 47:3442–3447.Google Scholar
13. Burgess, DS, Hall, RG 2nd, Lewis, JS 2nd, Jorgensen, JH, Patterson, JE. Clinical and microbiologic analysis of a hospital's extended-spectrum beta-lactamase-producing isolates over a 2-year period. Pharmacotherapy 2003; 23:1232–1237.Google Scholar
14. Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993; 119:353–358.CrossRefGoogle ScholarPubMed
15. Paterson, DL, Ko, WC, Von Gottberg, A, et al. Antibiotic therapy for Klebsiella pneumoniae bacteremia: implications of production of extended-spectrum beta-lactamases. Clin Infect Dis 2004; 39:31–37.CrossRefGoogle ScholarPubMed
16. Kang, CI, Kim, SH, Park, WB, et al. Bloodstream infections due to extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother 2004; 48:4574–4581.Google Scholar
17. Hyle, EP, Lipworth, AD, Zaoutis, TE, Nachamkin, I, Bilker, WB, Lautenbach, E. Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum beta-lactamase–producing Enterobacteriaceae: variability by site of infection. Arch Intern Med 2005; 165:1375–1380.Google Scholar
18. Lodise, TP, McKinnon, PS. Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2005; 52:113–122.Google Scholar
19. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26:166–174.CrossRefGoogle ScholarPubMed
20. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36:592–598.CrossRefGoogle ScholarPubMed
21. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement. 15th ed. Wayne, PA: CLSI; 2005.Google Scholar
22. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–829.CrossRefGoogle ScholarPubMed
23. Paterson, DL, Singh, N, Gayowski, T, Marino, IR. Fatal infection due to extended-spectrum beta-lactamase–producing Escherichia coli: implications for antibiotic choice for spontaneous bacterial peritonitis. Clin Infect Dis 1999; 28:683–684.Google Scholar
24. Paterson, DL, Mulazimoglu, L, Casellas, TM, et al. Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum beta-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 2000; 30:473–478.Google Scholar
25. Paterson, DL, Ko, WC, Von Gottberg, A, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001; 39:2206–2212.CrossRefGoogle ScholarPubMed
26. Thomson, KS, Moland, ES. Cefepime, piperacillin-tazobactam, and the inoculum effect in tests with extended-spectrum beta-lactamase–producing Enterobacteriaceae. Antimicrob Agents Chemother 2001; 45:3548–3554.CrossRefGoogle ScholarPubMed
27. Maglio, D, Ong, C, Banevicius, MA, Geng, Q, Nightingale, CH, Nicolau, DP. Determination of the in vivo pharmacodynamic profile of cefepime against extended-spectrum-beta-lactamase-producing Escherichia coli at various inocula. Antimicrob Agents Chemother 2004; 48:1941–1947.Google Scholar
28. Andes, D, Craig, W. Impact of extended-spectrum beta-lactamase (ESBL) production on the activity of cefepime in a murine-thigh infection model. In: Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy (Illinois); December 16-19, 2001; Chicago. Abstract A1099.Google Scholar