Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital

Abstract

BackgroundThe emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital.MethodsWe conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection.ResultsMultivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01).ConclusionMany factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.

Factors associated with acquisition of carbapenem-resistant Enterobacteriaceae

“…Having surgery was a risk factor for acquiring CRE. This finding is in agreement with a previous study that described surgery as being more common in patients with CRE infection, and corroborates the finding that medical procedures play a significant role in increased susceptibility of hospitalized patients to certain infections 24 .…”

Risk factors and outcomes for carbapenem-resistant Klebsiella pneumoniae bacteremia in onco-hematological patients

“…Several risk factors for the occurrence of carbapenem-resistant (CR) bacteremia have been reported in different studies [13,14]. Wang Q et al pointed out that previous use of third-or fourthgeneration cephalosporins and carbapenems was an independent risk factor for carbapenem resistant Enterobacteriaceae infection in 94 episodes of nosocomial infections [15].…”

Antibiotic Resistance Profile and Diversity of Subtypes Genes in Escherichia coli Causing Bloodstream Infection in Northern Vietnam

“…Finding the appropriate therapy became crucial and carbapenems emerged as 'best therapy' for ESBLproducing bacteria [25]. But in the time of antibiotics and resistance becoming popular, E. Coli also starts resistance to carbapenem that leading a high financial burden and increased mortality [27].…”