Attributable clinical and economic burden of carbapenem-non-susceptible Gram-negative infections in patients hospitalized with complicated urinary tract infections

Abstract

Background: Gram-negative complicated urinary tract infections (cUTIs) can have serious consequences for patients and hospitals. Aim: To examine the clinical and economic burden attributable to Gram-negative carbapenem-non-susceptible (C-NS; resistant/intermediate) infections compared with carbapenem-susceptible (C-S) infections in 78 US hospitals. Methods: All non-duplicate C-NS and C-S urine source isolates were analysed. A subset had principal diagnosis ICD-9-CM codes denoting cUTI. Collection time (<3 vs 3 days after admission) determined isolate classification as community or hospital onset. Mortality, 30day re-admissions, length of stay (LOS), hospital cost and net gain/loss in US dollars were determined for C-NS and C-S cases, with the C-NS-attributable burden estimated through propensity score matching. Three subgroups with adequate patient numbers were analysed: cUTI principal diagnosis, community onset; other principal diagnosis, community onset; and other principal diagnosis, hospital onset. Findings: The C-NS-attributable mortality risk was significantly higher (58%) for the other principal diagnosis, hospital-onset subgroup alone (odds ratio 1.58, 95% confidence interval 1.14e2.20; P < 0.01). The C-NS-attributable risk for 30-day re-admission ranged from 29% to 55% (all P < 0.05). The average attributable economic impact of C-NS was 1.1 e3.9 additional days LOS (all P < 0.05), US$1512e10,403 additional total cost (all P < 0.001) and US$1582e11,848 net loss (all P < 0.01); overall burden and C-NS-attributable burden were greatest in the other principal diagnosis, hospital-onset subgroup. Conclusion: Greater clinical and economic burden was observed in propensity-score-matched patients with C-NS infections compared with C-S infections, regardless of whether cUTI was the principal diagnosis, and this burden was most severe in hospital-onset infections.

Clinical and Economic Burden of Carbapenem-Resistant Infection or Colonization Caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii: A Multicenter Study in China

“…Recently published studies mainly focus on gram-positive bacteria [ 9 ], while only few studies estimated the burden of CRKP, CRPA, and CRAB in terms of mortality, length of stay (LOS), and cost [ 10 , 11 , 12 , 13 , 14 ]. It was reported that patients with CRKP, CRPA, and CRAB infections were associated with higher mortality, longer hospital stay, and higher hospital costs compared with carbapenem susceptible cases [ 9 , 15 , 16 , 17 ]. In addition, hospital costs incurred by colonized patients with CRKP were also high [ 18 ].…”

<p>Contributing Factors to the Clinical and Economic Burden of Patients with Laboratory-Confirmed Carbapenem-Nonsusceptible Gram-Negative Respiratory Infections</p>

“…The current study expanded on a recent study that demonstrated an increased clinical and economic burden of complicated UTIs caused by carbapenem-nonsusceptible gram-negative pathogens. 9 To our knowledge, this is the first study to focus on predictor variables in a UTI population with laboratory-confirmed carbapenem-nonsusceptible infections, in contrast to previous studies that have either assessed variables and burden in patients with a variety of infection types [16][17][18] or with UTIs caused by pathogens with unknown carbapenem susceptibility. 22 Our study population included patients who presented to a broad sample of acute-care health care institutions in the US (n=78) where laboratory-confirmed microbiological nonsusceptibility to carbapenems was established in a large number of urine source isolates (>40,000).…”

“…The overall mortality rate was 5.5% (n=79/1439), and the allcause readmission rate was 25.0% (n=340/1360 live discharges). The mean (standard deviation [SD]) LOS was 12 (14) days, and the median (interquartile range [IQR]) was 12 (8)(9)(10)(11)(12)(13)(14) days. The mean (SD) total cost per case was $21,502 ($37,172), and the median (IQR) was $11,231 ($6384-$21,850).…”

“…[6][7][8] In a recent multicenter study of propensity score-matched cohorts with carbapenem-nonsusceptible versus carbapenemsusceptible infections, carbapenem-nonsusceptible status was associated with a significantly increased mortality risk in hospital-onset cases and a significantly increased risk of 30day readmissions, increased length of stay (LOS), and increased total cost regardless of onset setting. 9 To better understand the risk factors associated with worse clinical and economic outcomes among patients who have the greatest and most acute burden due to carbapenem-nonsusceptible UTIs, we further examined patient-and hospital-level predictor variables for the entire carbapenem-nonsusceptible UTI cohort.…”

>b<Premating stress alters the vaginal microbiota of gilts>/b<

“…Comparing microbiota from O and C gilts, it was found a higher prevalence of Enterobacter and Klebsiella in C animals (p<0.003), both associated with urinary infections in humans (KOKSAL et al, 2019;GOYAL et al, 2019;TABAK et al, 2019).…”