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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

Published online by Cambridge University Press:  02 January 2015

Andrew Stewardson ,
Carolina Fankhauser ,
Giulia De Augelis ,
Peter Rohner ,
Edith Safran ,
Jacques Schrenzel ,
Didier Pittet  and
Stephan Harbarth
Andrew Stewardson*
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Carolina Fankhauser
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Giulia De Augelis
Affiliation:
Division of Infectious Diseases, Università Cattolica Sacro Cuore, Rome, Italy
Peter Rohner
Affiliation:
Health-Economic Unit, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Edith Safran
Affiliation:
Health-Economic Unit, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Jacques Schrenzel
Affiliation:
Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
Didier Pittet
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Service de Prévention et Contrôle de l'Infection, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland ([email protected])
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Abstract

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 133 - 143
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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