Economic impact of an outbreak of carbapenemase producing-Enterobacteriaceae in a surgical intensive care unit

Atchade, Enora; Goldstein, Valérie; Viane, Sophie; Gysel, Damien van; Lolom, Isabelle; Lortat‐Jacob, Brice; Tran-Dinh, Alexy; Rehouma, Mouna Ben; Lucet, Jean‐Christophe; Montravers, Philippe

doi:10.1016/j.accpm.2022.101093

Cited by 3 publications

(4 citation statements)

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“…Furthermore, the prevention of CRE transmission incurs a substantial economic burden. In a surgical ICU, the financial costs accrued from CRE outbreaks in 3 years was approximately €1,300,000 ( Atchade et al, 2022 ). Therefore, decreasing the risk for CRE acquisition and ensuring active surveillance for the detection of CRE carriers is essential in the ICU ( Yi and Kim, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis

Baek

Kim

et al. 2023

Front. Microbiol.

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BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) are an emerging concern for global health and are associated with high morbidity and mortality in critically ill patients. Risk factors for CRE acquisition include broad-spectrum antibiotic use and microbiota dysbiosis in critically ill patients. Therefore, we evaluated the alteration of the intestinal microbiota associated with CRE colonization in critically ill patients.MethodsFecal samples of 41 patients who were diagnosed with septic shock or respiratory failure were collected after their admission to the intensive care unit (ICU). The gut microbiota profile determined using 16S rRNA gene sequencing and quantitative measurement of fecal short-chain fatty acids were evaluated in CRE-positive (n = 9) and CRE negative (n = 32) patients. The analysis of bacterial metabolic abundance to identify an association between CRE acquisition and metabolic pathway was performed.ResultsCRE carriers showed a significantly increased proportion of the phyla Proteobacteria and decreased numbers of the phyla Bacteroidetes as compared to the CRE non-carriers. Linear discriminant analysis (LDA) with linear discriminant effect size showed that the genera Erwinia, Citrobacter, Klebsiella, Cronobacter, Kluyvera, Dysgomonas, Pantoea, and Alistipes had an upper 2 LDA score in CRE carriers. The alpha-diversity indices were significantly decreased in CRE carriers, and beta-diversity analysis demonstrated that the two groups were clustered significantly apart. Among short-chain fatty acids, the levels of isobutyric acid and valeric acid were significantly decreased in CRE carriers. Furthermore, the PICRUSt-predicted metabolic pathways revealed significant differences in five features, including ATP-binding cassette transporters, phosphotransferase systems, sphingolipid metabolism, other glycan degradation, and microbial metabolism, in diverse environments between the two groups.ConclusionCritically ill patients with CRE have a distinctive gut microbiota composition and community structure, altered short-chain fatty acid production and changes in the metabolic pathways. Further studies are needed to determine whether amino acids supplementation improves microbiota dysbiosis in patients with CRE.

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Section: Introductionmentioning

confidence: 99%

Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis

Baek

Kim

et al. 2023

Front. Microbiol.

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“…12 These costs, resulting from increased lengths of stay and restricted admissions, highlight the considerable impact that a small CPE outbreak can have on the wider health care system. 12 Australia's only published economic estimate of the financial cost associated with asymptomatic CPE colonisation found that affected individuals had, on average, six times higher health care costs ($155 784) compared with non-colonised individuals ($25 964) of a similar age and clinical presentation. 13 A recent WHO report projected a cumulative total of 5.2 million antimicrobial resistance-related deaths in the Western Pacific region from 2020 to 2030, with economic costs forecast to reach US$148 billion, indicating the enormity of the problem in our region.…”

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confidence: 99%

“…A recent 40‐case outbreak in the United Kingdom is estimated to have cost the National Health Service the equivalent of AU$1.7 million 11 . In France, a 19‐month outbreak involving only 16 patients with CPE infection was estimated to have cost an individual hospital the equivalent of AU$2 million 12 . These costs, resulting from increased lengths of stay and restricted admissions, highlight the considerable impact that a small CPE outbreak can have on the wider health care system 12 .…”

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confidence: 99%

“…In France, a 19‐month outbreak involving only 16 patients with CPE infection was estimated to have cost an individual hospital the equivalent of AU$2 million 12 . These costs, resulting from increased lengths of stay and restricted admissions, highlight the considerable impact that a small CPE outbreak can have on the wider health care system 12 . Australia's only published economic estimate of the financial cost associated with asymptomatic CPE colonisation found that affected individuals had, on average, six times higher health care costs ($155 784) compared with non‐colonised individuals ($25 964) of a similar age and clinical presentation 13 .…”

mentioning

confidence: 99%

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