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Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model

Stewardson, Andrew ; Fankhauser, Carolina ; Augelis, Giulia De ; Rohner, Peter ; Safran, Edith ; Schrenzel, Jacques ; Pittet, Didier ; Harbarth, Stephan

In: Infection Control & Hospital Epidemiology, 2013, vol. 34, no. 2, p. 133-143

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    Title
    • Burden of Bloodstream Infection Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model
    Author
    • Stewardson, Andrew. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Fankhauser, Carolina. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Augelis, Giulia De. Division of Infectious Diseases, Università Cattolica Sacro Cuore, Rome, Italy
    • Rohner, Peter. Health-Economic Unit, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Safran, Edith. Health-Economic Unit, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Schrenzel, Jacques. Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
    • Pittet, Didier. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Harbarth, Stephan. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Infection Control & Hospital Epidemiology, 2013, vol. 34, no. 2, p. 133-143. Cambridge University Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:290600
    Summary
    Objective. To obtain an unbiased estimate of the excess hospital length of stay (LOS) and cost attributable to extended-spectrum β-lactamase (ESBL) positivity in bloodstream infections (BSIs) due to Enterobacteriaceae. Design. Retrospective cohort study. Setting. A 2,200-bed academic medical center in Geneva, Switzerland. Patients. Patients admitted during 2009. Methods. We used multistate modeling and Cox proportional hazards models to determine the excess LOS and adjusted end-of-LOS hazard ratio (HR) for ESBL-positive and ESBL-negative BSI. We estimated economic burden as the product of excess LOS and average bed-day cost. Patient-level accounting data provided a complementary analysis of economic burden. A predictive model was fitted to national surveillance data. Results. Thirty ESBL-positive and 96 ESBL-negative BSI cases were included. The excess LOS attributable to ESBL-positive and ESBL-negative BSI was 9.4 (95% confidence interval [CI], 0.4-18.4) and 2.6 (95% CI, 0.7-5.9) days, respectively. ESBL positivity was therefore associated with 6.8 excess days and CHF 9,473 per BSI. The adjusted end-of-LOS HRs for ESBL-positive and ESBL-negative BSI were 0.62 (95% CI, 0.43-0.89) and 0.90 (95% CI, 0.74-1.10), respectively. After reimbursement, the average financial loss per acute care episode in ESBL-positive BSI, ESBL-negative BSI, and control cohorts was CHF 48,674, 48,131, and 13,532, respectively. Our predictive model estimated that the nationwide cost of third-generation cephalosporin resistance would increase from CHF 2,084,000 in 2010 to CHF 3,526,000 in 2015. Conclusions. This is the first hospital-wide analysis of excess LOS attributable to ESBL positivity determined using multistate modeling to avoid time-dependent bias. These results may inform health-economic evaluations of interventions targeting ESBL control