Cargando…

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent...

Descripción completa

Detalles Bibliográficos
Autores principales: Suzuki, Hiroyuki, Perencevich, Eli N, Nair, Rajeshwari, Livorsi, Daniel J, Goto, Michihiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168210/
https://www.ncbi.nlm.nih.gov/pubmed/32102195
http://dx.doi.org/10.3390/antibiotics9020096
_version_ 1783523635485474816
author Suzuki, Hiroyuki
Perencevich, Eli N
Nair, Rajeshwari
Livorsi, Daniel J
Goto, Michihiko
author_facet Suzuki, Hiroyuki
Perencevich, Eli N
Nair, Rajeshwari
Livorsi, Daniel J
Goto, Michihiko
author_sort Suzuki, Hiroyuki
collection PubMed
description Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E. coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions.
format Online
Article
Text
id pubmed-7168210
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-71682102020-04-21 Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis Suzuki, Hiroyuki Perencevich, Eli N Nair, Rajeshwari Livorsi, Daniel J Goto, Michihiko Antibiotics (Basel) Article Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E. coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions. MDPI 2020-02-23 /pmc/articles/PMC7168210/ /pubmed/32102195 http://dx.doi.org/10.3390/antibiotics9020096 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Suzuki, Hiroyuki
Perencevich, Eli N
Nair, Rajeshwari
Livorsi, Daniel J
Goto, Michihiko
Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title_full Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title_fullStr Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title_full_unstemmed Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title_short Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis
title_sort excess length of acute inpatient stay attributable to acquisition of hospital-onset gram-negative bloodstream infection with and without antibiotic resistance: a multistate model analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168210/
https://www.ncbi.nlm.nih.gov/pubmed/32102195
http://dx.doi.org/10.3390/antibiotics9020096
work_keys_str_mv AT suzukihiroyuki excesslengthofacuteinpatientstayattributabletoacquisitionofhospitalonsetgramnegativebloodstreaminfectionwithandwithoutantibioticresistanceamultistatemodelanalysis
AT perencevichelin excesslengthofacuteinpatientstayattributabletoacquisitionofhospitalonsetgramnegativebloodstreaminfectionwithandwithoutantibioticresistanceamultistatemodelanalysis
AT nairrajeshwari excesslengthofacuteinpatientstayattributabletoacquisitionofhospitalonsetgramnegativebloodstreaminfectionwithandwithoutantibioticresistanceamultistatemodelanalysis
AT livorsidanielj excesslengthofacuteinpatientstayattributabletoacquisitionofhospitalonsetgramnegativebloodstreaminfectionwithandwithoutantibioticresistanceamultistatemodelanalysis
AT gotomichihiko excesslengthofacuteinpatientstayattributabletoacquisitionofhospitalonsetgramnegativebloodstreaminfectionwithandwithoutantibioticresistanceamultistatemodelanalysis