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.

A.J. Stewardson (1) , Arthur Allignol (2) , Jan Beyersmann (2) , Nicholas Graves (3) , Martin Schumacher (4) , Rodolphe Meyer (5) , Evelina Tacconelli (6) , Giulia de Angelis (7) , Claudio Farina (8) , Fabio Pezzoli (9) , Xavier Bertrand (10) , Houssein Gbaguidi-Haore (11) , Jonathan Edgeworth (12) , Olga Tosas (13) , Jose A Martinez (14, 15) , M Pilar Ayala-Blanco (16) , Angelo Pan (17) , Alessia Zoncada (18) , Charis A Marwick (19) , Dilip Nathwani (19) , Harald Seifert (20) , Nina Hos (13) , Stefan Hagel (21) , Mathias Pletz (21) , Stephan Harbarth (1)

1 Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
2 FDM - Freiburg Center for Data Analysis and Modeling
3 IHBI - Institute of Health and Biomedical Innovation
4 LBMCC - Laboratoire de Biologie Moléculaire et Cellulaire du Cancer [Luxembourg]
5 HUG - Geneva University Hospital
6 Department of Infectious Diseases
7 INFN Laboratori Nazionali di Legnaro
8 Unità di Microbiologia
9 Hosp P Giovanni XXIII - Hospital Papa Giovanni XXIII
10 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
11 LCE - Laboratoire Chrono-environnement (UMR 6249)
12 School of Immunology and Microbial Sciences - Department of Infectious Diseases [London, UK]
13 Uniklinik Köln - Universitätsklinikum Köln
14 EST - Études sur les Sciences et les Techniques
15 GHDSO - Groupe d'histoire et diffusion des sciences d'Orsay
16 Hospital Clínic de Barcelona [Catalonia, Spain]
17 Divisione di Malattie Infettive
18 Istituti Ospitalieri di Cremona
19 Ninewells Hospital and Medical School [Dundee]
20 Northwestern University Feinberg School of Medicine
21 Jena University Hospital [Jena]

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34-2.42, HR = 1.81; 95% CI: 1.49-2.20 and HR = 2.42; 95% CI: 1.66-3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2-9.4, 11.5 days; 95% CI: 11.5-11.6 and 13.3 days; 95% CI: 13.2-13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8-5.9) but not hazard of death (1.16; 95% CI: 0.98-1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13-2.35), excess LOS (4.9 days; 95% CI: 1.1-8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

Mots clés: Antimicrobial resistance; Escherichia coli; Meticillin-resistant Staphylococcus aureus (MRSA) in humans; Staphylococcus aureus; bacterial infections; bloodstream infection; multidrug resistance

Domaines: Microbiologie et Parasitologie

A.J. Stewardson, Arthur Allignol, Jan Beyersmann, Nicholas Graves, Martin Schumacher, 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), ⟨10.2807/1560-7917.ES.2016.21.33.30319⟩. ⟨hal-01506821⟩