Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China

Xuemei Zhen, Cecilia Stålsby Lundborg, Xueshan Sun, Xiaoqian Hu and Hengjin Dong
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Xuemei Zhen: Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, (National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University), Jinan 250012, China
Cecilia Stålsby Lundborg: Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
Xueshan Sun: Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
Xiaoqian Hu: Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
Hengjin Dong: Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China

IJERPH, 2020, vol. 17, issue 24, 1-12

Abstract: Quantifying economic and clinical outcomes for interventions could help to reduce third-generation cephalosporin resistance and Escherichia coli or Klebsiella pneumoniae . We aimed to compare the differences in clinical and economic burden between third-generation cephalosporin-resistant E. coli (3GCREC) and third-generation cephalosporin-susceptible E. coli (3GCSEC) cases, and between third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and third-generation cephalosporin-susceptible K. pneumoniae (3GCSKP) cases. A retrospective and multicenter study was conducted. We collected data from electronic medical records for patients who had clinical samples positive for E. coli or K. pneumoniae isolates during 2013 and 2015. Propensity score matching (PSM) was conducted to minimize the impact of potential confounding variables, including age, sex, insurance, number of diagnoses, Charlson comorbidity index, admission to intensive care unit, surgery, and comorbidities. We also repeated the PSM including length of stay (LOS) before culture. The main indicators included economic costs, LOS and hospital mortality. The proportions of 3GCREC and 3GCRKP in the sampled hospitals were 44.3% and 32.5%, respectively. In the two PSM methods, 1804 pairs and 1521 pairs were generated, and 1815 pairs and 1617 pairs were obtained, respectively. Compared with susceptible cases, those with 3GCREC and 3GCRKP were associated with significantly increased total hospital cost and excess LOS. Inpatients with 3GCRKP were significantly associated with higher hospital mortality compared with 3GCSKP cases, however, there was no significant difference between 3GCREC and 3GCSEC cases. Cost reduction and outcome improvement could be achieved through a preventative approach in terms of both antimicrobial stewardship and preventing the transmission of organisms.

Keywords: Escherichia coli; Klebsiella pneumoniae; third-generation cephalosporin; 3GCREC; 3GCRKP; economic cost; length of stay; hospital mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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