The impact of carbapenem-resistant Pseudomonas aeruginosa on clinical and economic outcomes in a Chinese tertiary care hospital: A propensity score–matched analysis

Chen, Zhihui; Xu, Zhifeng; Wang, Hongmei; Chen, Le; Gao, Shengchun; Chen, Yangfang

doi:10.1016/j.ajic.2018.10.025

Cited by 13 publications

(17 citation statements)

References 28 publications

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“…For P. aeruginosa , median total hospital cost for inpatients with CRPA was 1.23 times − 1.68 times higher than that for those with CSPA after balancing baseline characteristics [91, 92], ranging from $1065 in China [91] to $45,322 in the US [92]. In univariate analyses, CRPA contributed to 1.51 times of mean hospital cost after culture than CSPA [95], and Eagye et al found that inpatients with CRPA were associated with 3.09 times median total cost (indirect and direct cost) as high as CSPA cases and 3.91 times higher than those without infection [97].…”

Section: Resultsmentioning

confidence: 99%

Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

Zhen

Lundborg

Sun

et al. 2019

Antimicrob Resist Infect Control

243

159

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Background Antibiotic resistance (ABR) is one of the biggest threats to global health. Infections by ESKAPE ( Enterococcus , S. aureus , K. pneumoniae , A. baumannii , P. aeruginosa , and E. coli ) organisms are the leading cause of healthcare-acquired infections worldwide. ABR in ESKAPE organisms is usually associated with significant higher morbidity, mortality, as well as economic burden. Directing attention towards the ESKAPE organisms can help us to better combat the wide challenge of ABR, especially multi-drug resistance (MDR). Objective This study aims to systematically review and evaluate the evidence of the economic consequences of ABR or MDR ESKAPE organisms compared with susceptible cases or control patients without infection/colonization in order to determine the impact of ABR on economic burden. Methods Both English-language databases and Chinese-language databases up to 16 January, 2019 were searched to identify relevant studies assessing the economic burden of ABR. Studies reported hospital costs (charges) or antibiotic cost during the entire hospitalization and during the period before/after culture among patients with ABR or MDR ESKAPE organisms were included. The costs were converted into 2015 United States Dollars. Disagreements were resolved by a third reviewer. Results Of 13,693 studies identified, 83 eligible studies were included in our review. The most studied organism was S. aureus , followed by Enterococcus , A. baumannii , E. coli , E. coli or/and K. pneumoniae , P. aeruginosa , and K. pneumoniae . There were 71 studies on total hospital cost or charge, 12 on antibiotic cost, 11 on hospital cost or charge after culture, 4 on ICU cost, 2 on hospital cost or charge before culture, and 2 on total direct and indirect cost. In general, ABR or MDR ESKAPE organisms are significantly associated with higher economic burden than those with susceptible organisms or those without infection or colonization. Nonetheless, there were no differences in a few studies between the two groups on total hospital cost or charge (16 studies), antibiotic cost (one study), hospital cost before culture (one study), hospital cost after culture (one study). Even, one reported that costs associated with MSSA infection were higher than the costs for similar MRSA cases. Conclusions ABR in ESKAPE organisms is not always, but usually, associated with significantly higher economic burden. The results without significant differences may lack statistical power to detect a significant association. In addition, study design ...

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Section: Resultsmentioning

confidence: 99%

Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

Zhen

Lundborg

Sun

et al. 2019

Antimicrob Resist Infect Control

243

159

View full text Add to dashboard Cite

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“…A total of 48 full-text manuscripts were assessed for the second round of inclusion criteria, with 28 (58.3%) being excluded for not fulfilling the criteria (kappa = 0.96). A total of 20 studies were included in the review, with 14,448 patients included [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]. Out of the 20 studies, 19 presented in hospital length of stay, 14 presented mortality data and 12 cost outcomes.…”

Section: Resultsmentioning

confidence: 99%

Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis

et al. 2020

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Background Infections with multidrug resistant (MDR) bacteria in hospital settings have substantial implications in terms of clinical and economic outcomes. However, due to clinical and methodological heterogeneity, estimates about the attributable economic and clinical effects of healthcare-associated infections (HAI) due to MDR microorganisms (MDR HAI) remain unclear. The objective was to review and synthesize the evidence on the impact of MDR HAI in adults on hospital costs, length of stay, and mortality at discharge. Methods and findings Literature searches were conducted in PubMed/MEDLINE, and Google Scholar databases to select studies that evaluated the impact of MDR HAI on economic and clinical outcomes. Eligible studies were conducted in adults, in order to ensure homogeneity of populations, used propensity score matched cohorts or included explicit confounding control, and had confirmed antibiotic susceptibility testing. Risk of bias was evaluated, and effects were measured with ratios of means (ROM) for cost and length of stay, and risk ratios (RR) for mortality. A systematic search was performed on 14 th March 2019, rerun on the 10 th of June 2019 and extended the 3 rd of September 2019. Small effect sizes were assessed by examination of funnel plots. Sixteen articles (6,122 patients with MDR HAI and 8,326 patients with non-MDR HAI) were included in the systematic review of which 12 articles assessed cost, 19 articles length of stay, and 14 mortality. Compared to susceptible infections, MDR HAI were associated with increased cost (

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“…A total of 29 studies reported data on hospital mortality [27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]. We found ABR had a significant impact on mortality in 22 studies (Table 1, Table S1 in Supplementary data 2).…”

Section: Resultsmentioning

confidence: 99%

“…We found ABR had a significant impact on mortality in 22 studies (Table 1, Table S1 in Supplementary data 2). Three studies included two different comparisons based on different study designs [38,43,51], two different comparisons contributed data for both susceptible bacterial infections and those without infections in two studies [45,55], and two other studies contained two and four different descriptions of mortality (attributable or all-cause in hospital mortality/28-day (30-day) hospital mortality) [44,54]. Patients with infections due to ABR or MDR bacteria had a higher odds of overall mortality than those patients with susceptible bacterial infections or control patients without infection (OR: 2.67, 95% CI: 2.18–3.26, p = 0.001; OR: 3.29, 95% CI: 1.71–6.33, p = 0.001) with moderate heterogeneity ( I 2 = 52.5%, P <0.001) (Figure 3A), and low heterogeneity ( I 2 = 52.5%, p <0.001), respectively (Figure 3B).…”

Section: Resultsmentioning

confidence: 99%

The Clinical and Economic Impact of Antibiotic Resistance in China: A Systematic Review and Meta-Analysis

et al. 2019

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Antibiotic resistance (ABR) is one of the biggest threats to global health, especially in China. This study aims to analyze the published literature on the clinical and economic impact of ABR or multi-drug resistant (MDR) bacteria compared to susceptible bacteria or non-infection, in mainland China. English and Chinese databases were searched to identify relevant studies evaluating mortality, hospital stay, and hospital costs of ABR. A meta-analysis of mortality was performed using a random effects model. The costs were converted into 2015 United States (US) dollars. Of 13,693 studies identified, 44 eligible studies were included. Twenty-nine investigated the impact of ABR on hospital mortality, 37 were focused on hospital stay, and 21 on hospital costs. Patients with ABR were associated with a greater risk of overall mortality compared to those with susceptibility or those without infection (odds ratio: 2.67 and 3.29, 95% confidence interval: 2.18–3.26 and 1.71–6.33, p < 0.001 and p < 0.001, respectively). The extra mean total hospital stay and total hospital cost were reported, ranging from 3 to 46 days, and from US$238 to US$16,496, respectively. Our study indicates that ABR is associated with significantly higher mortality. Moreover, ABR is not always, but usually, associated with significantly longer hospital stay and higher hospital costs.

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The impact of carbapenem-resistant Pseudomonas aeruginosa on clinical and economic outcomes in a Chinese tertiary care hospital: A propensity score–matched analysis

Cited by 13 publications

References 28 publications

Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis

The Clinical and Economic Impact of Antibiotic Resistance in China: A Systematic Review and Meta-Analysis

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