Social-Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia Coli
Background: The prevalence of infections with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing worldwide, but the economic impact of ESBL-EC bloodstream infections (BSI) has not been comprehensively evaluated.Methods: A retrospective cohort including patients hospitalized at a tertiary hospital between January 2013 and December 2016 who confirmed with BSI of ESBL-EC or non-ESBL-EC was set. Clinical data and medical costs were collected by chart review of
... review of electronic and paper medical records. The socio-economic burden was evaluated with DALYs.Results: A total of 580 patients with E. coli BSI, comprising 333 patients (57.4%) with ESBL-EC BSI and 247 patients (42.6%) with non-ESBL-EC BSI, were identified. There were no significant differences in comorbidity and severity of patients between ESBL-EC and non-ESBL-EC BSIs. The median length of stay (LOS) after bacteremia was 12 days for ESBL-EC(interquartile range, 7 to 21), versus 11 days for non-ESBL-EC (interquartile range, 7 to 21) (P =0.38), and appropriate empirical antimicrobial therapy occurred in 87.4% versus 89.9% (P =0.353). The mortalities were 20.1% versus 17.4% (P =0.41). Patients with ESBL-EC did not have significant difference in-hospital medical costs than those with non-ESBL-EC (median, $8048.68 vs $7476.84, respectively,with a difference of $571.84,P=0.321). In non-ESBL-EC group, 247 patients lost 531.05 DALYs in total, with an average of 2.15 DALYs per person,while in ESBL-EC group, 333 patients lost 692.64 DALYs in total, with an average of 2.08 DALYs per person. There is no significant difference in average DALY(P=0.343).Conclusions: In conclusion, patients with BSI due to ESBL-EC did not cost more than patients with BSI due to non-ESBL-EC. This phenomenon may be attributed to timely and effective antibiotic treatment,but the intitial empiric thrapy with second or third line antibitoics in non-ESBL-EC BSI should be corrected.