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Impact of Extended-Spectrum β-Lactamase–Producing Escherichia coli and Klebsiella Species on Clinical Outcomes and Hospital Costs: A Matched Cohort Study

Published online by Cambridge University Press:  21 June 2016

Su Young Lee ,
Srividya Kotapati ,
Joseph L. Kuti ,
Charles H. Nightingale  and
David P. Nicolau
Su Young Lee
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
Srividya Kotapati
Affiliation:
University of Massachusetts Medical School, Worcester, Massachusetts
Joseph L. Kuti
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
Charles H. Nightingale
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
David P. Nicolau*
Affiliation:
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
*
Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102 ([email protected])
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Abstract

Objectives.

To evaluate the economic and clinical impact of infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK).

Design.

A matched-cohort analysis of the cost of illness.

Setting.

An 810-bed, urban, community hospital in Hartford, Connecticut.

Patients.

Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non–ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received.

Results.

Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P = .034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days] P = .006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P = .027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P = .013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen.

Conclusion.

The cost of non–urinary tract infections caused by ESBL-EK was 1.7 times the cost of non–urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1226 - 1232
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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