The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study

English version

Autoři: Nichola R. Naylor ^aff001; Koen B. Pouwels ^aff002; Russell Hope ^aff004; Nathan Green ^aff005; Katherine L. Henderson ^aff004; Gwenan M. Knight ^aff001; Rifat Atun ^aff001; Julie V. Robotham ^aff001; Sarah R. Deeny ^aff007
Působiště autorů: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, England ^aff001; Modelling and Economics Unit, National Infection Service, Public Health England, London, England ^aff002; Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ^aff003; Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, London, England ^aff004; Department of Infectious Disease Epidemiology, Imperial College London, England ^aff005; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America ^aff006; The Health Foundation, London, England ^aff007
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0221944

Souhrn

Introduction

Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting.

Materials and methods

This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.

Results

14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62–6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84–2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50–1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220–630).

Conclusions

E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.

Klíčová slova:

Biology and life sciences – Microbiology – Microbial control – Antimicrobials – Antibiotics – Medical microbiology – Microbial pathogens – Bacterial pathogens – Escherichia coli – Organisms – Bacteria – Enterobacteriaceae – Escherichia – Gut bacteria – Population biology – Population metrics – Death rates – Medicine and health sciences – Pharmacology – Antimicrobial resistance – Antibiotic resistance – Drugs – Infectious diseases – Bacterial diseases – Escherichia coli infections – Health care – Health care facilities – Hospitals – Health economics – Pathology and laboratory medicine – Pathogens – Research and analysis methods – Animal studies – Experimental organism systems – Model organisms – Prokaryotic models – Social sciences – Economics

Zdroje

1. World Health Organization. Antimicrobial resistance: global report on surveillance. World Heal Organ [Internet]. 2014; Available from: http://apps.who.int/iris/handle/10665/112642

2. European Centre for Disease Prevention and Control. Proposals for draft EU guidelines on the prudent use of antimicrobials in human medicine. 2016.

3. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Current [Internet]. 2013;1–114. Available from: http://www.cdc.gov/drugresistance/threat-report-2013/index.html

4. Department of Health, Department for Environment Food and Rural Affairs. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018 [Internet]. 2013. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf

5. The AMR Review. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations the Review on Antimicrobial Resistance [Internet]. 2016. Available from: https://amr-review.org/Publications

6. Department of Health. Reducing infections in the NHS [Internet]. 2016 [cited 2017 Jun 19]. Available from: https://www.gov.uk/government/news/reducing-infections-in-the-nhs

7. Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) 2010 to 2014. 2015;

8. de Kraker ME a, Wolkewitz M, Davey PG, et al. Burden of antimicrobial resistance in European hospitals: Excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. J Antimicrob Chemother. 2011;66(2):398–407. doi: 10.1093/jac/dkq412 21106563

9. Jackson L a, Benson P, Neuzil KM, Grandjean M, Marino JL. Burden of community-onset Escherichia coli bacteremia in seniors. J Infect Dis [Internet]. 2005;191(9):1523–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15809912 doi: 10.1086/429344 15809912

10. de Kraker MEA, Stewardson AJ, Harbarth S. Will 10 Million People Die a Year due to Antimicrobial Resistance by 2050? PLoS Med. 2016;13(11):1–6.

11. Stewardson AJ, Allignol A, Beyersmann J, et al. 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. Eurosurveillance. 2016;21(33):1–12.

12. Abernethy JK, Johnson AP, Guy R, et al. Thirty day all-cause mortality in patients with Escherichia coli bacteraemia in England. Clin Microbiol Infect [Internet]. 2015;21(3):251.e1–251.e8. Available from: http://dx.doi.org/10.1016/j.cmi.2015.01.001

13. Stewardson A, Fankhauser C, De Angelis G, et al. Burden of bloodstream infection caused by extended-spectrum β-lactamase-producing enterobacteriaceae determined using multistate modeling at a Swiss University Hospital and a nationwide predictive model. Infect Control Hosp Epidemiol [Internet]. 2013;34(2):133–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23295559 doi: 10.1086/669086 23295559

14. Matt Dowle M, Srinivasan A, Gorecki J, et al. Package “data.table” [Internet]. CRAN. 2017. Available from: http://r-datatable.com

15. Allignol A. Package “etm.” CRAN. 2015.

16. Therneau T, Crowson C, Atkinson E, Crowson C, Atkinson E. Using Time Dependent Covariates and Time Dependent Coefficients in the Cox Model Time dependent covariates. CRAN. 2017.

17. Putter H, de Wreede L, Fiocco M, Geskus R. Package “mstate” [Internet]. 2016. Available from: http://www.msbi.nl/putter

18. Digital NHS. Estates Return Information Collection [Internet]. NHS Digital; [cited 2017 Mar 4]. Available from: http://hefs.hscic.gov.uk/ERIC.asp

19. Health & Social Care Information Centre. Hospital Episode Statistics [Internet]. [cited 2015 Oct 10]. Available from: http://www.hscic.gov.uk/hes

20. Bou-Antoun S, Davies J, Guy R, et al. Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014. Euro Surveill Bull [Internet]. 2016;21(35):1–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27608263%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5015457%0Ahttp://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22569

21. Health and Social Care Informfomation. Hospital Episode Statistics [Internet]. Hospital Episode Statisitics, Admissions and Diagnosis. 2015. Available from: http://www.hscic.gov.uk/hes

22. Green N, Johnson a. P, Henderson KL, et al. Quantifying the Burden of Hospital-Acquired Bloodstream Infection in Children in England by Estimating Excess Length of Hospital Stay and Mortality Using a Multistate Analysis of Linked, Routinely Collected Data. J Pediatric Infect Dis Soc [Internet]. 2014;1–8. Available from: doi: 10.1093/jpids/pit083

23. Graves N, Harbarth S, Beyersmann J, et al. Estimating the cost of health care-associated infections: mind your p’s and q’s. Clin Infect Dis. 2010;50(7):1017–21. doi: 10.1086/651110 20178419

24. Austin PC, Lee DS, Fine JP. Introduction to the Analysis of Survival Data in the Presence of Competing Risks. Circulation. 2016;133(6):601–9. doi: 10.1161/CIRCULATIONAHA.115.017719 26858290

25. Aalen OO, Johansen S. An empirical transition matrix for nonhomogeneous Markov chains based on censored observations. Scand J Stat [Internet]. 1978;5(3):141–50. Available from: http://www.jstor.org/stable/4615704

26. Bottle A, Aylin P. Comorbidity scores for administrative data benefited from adaptation to local coding and diagnostic practices. J Clin Epidemiol. 2011;64(12):1426–33. doi: 10.1016/j.jclinepi.2011.04.004 21764557

27. Beyersmann J, Wolkewitz M, Allignol A, Grambauer N, Schumacher M. Application of multistate models in hospital epidemiology: Advances and challenges. Biometrical J. 2011;53(2):332–50.

28. Department of Health. NHS reference costs: financial year 2011 to 2012 [Internet]. 2012 [cited 2015 May 19]. Available from: https://www.gov.uk/government/publications/nhs-reference-costs-financial-year-2011-to-2012

29. Holden S, Clarkson A. Guidelines for the Empirical Treatment of Sepsis in Adults (excluding Neutropenic Sepsis) [Internet]. 2018. Available from: https://www.nuh.nhs.uk/handlers/downloads.ashx?id=60988

30. National Institute for Health and Care Excellence (NICE). Sepsis: recognition, diagnosis and early management. 2016.

31. Dingle KE, Didelot X, Quan TP, et al. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lancet Infect Dis. 2017;17(4):411–21. doi: 10.1016/S1473-3099(16)30514-X 28130063

32. Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR). 2014;1–143. Available from: www.gov.uk/phe%5Cnwww.facebook.com/PublicHealthEngland

33. Pouwels KB, Vansteelandt S, Batra R, Edgeworth JD, Smieszek T, Robotham JV. Intensive care unit (ICU)-acquired bacteramia and ICU moratality and discharge: addressing time-varying confounding using appropriate methodology. J Hosp Infect. 2018;99(1):42–47. doi: 10.1016/j.jhin.2017.11.011 29175434

34. NHS England. Quality Premium: Guidance for 2016/17. 2016.

35. ECDC. Last-line antibiotics are failing: options to address this urgent threat to patients and healthcare systems. Ecdc Policy Brief. 2016;

36. Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR). 2017;1–143. Available from: www.gov.uk/phe%5Cnwww.facebook.com/PublicHealthEngland

The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study

Souhrn

Introduction

Materials and methods

Results

Conclusions

Klíčová slova:

Zdroje

PLOS One

INSIGHTS from European Respiratory Congress

Současné pohledy na riziko v parodontologii

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií