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Health and economic burden of antimicrobial-resistant infections in Australian hospitals: a population-based model

Published online by Cambridge University Press:  19 March 2019

Teresa M. Wozniak Open the ORCID record for Teresa M. Wozniak [Opens in a new window] ,
Emily J. Bailey  and
Nicholas Graves
Teresa M. Wozniak*
Affiliation:
Menzies School of Health Research, Royal Darwin Hospital, Rocklands Drive, Tiwi, Darwin, Northern Territory, 0810, Australia Centre for Research Excellence, Reducing Healthcare-Associated Infections, Australian Centre for Health Services Innovation, Queensland University of Technology, Queensland, Australia
Emily J. Bailey
Affiliation:
Centre for Research Excellence, Reducing Healthcare-Associated Infections, Australian Centre for Health Services Innovation, Queensland University of Technology, Queensland, Australia
Nicholas Graves
Affiliation:
Centre for Research Excellence, Reducing Healthcare-Associated Infections, Australian Centre for Health Services Innovation, Queensland University of Technology, Queensland, Australia
*
Author for correspondence: Teresa M. Wozniak, Email: [email protected]
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Abstract

Objective:

To estimate the additional health and economic burden of antimicrobial-resistant (AMR) infections in Australian hospitals.

Methods:

A simulation model based on existing evidence was developed to assess the additional mortality and costs of healthcare-associated AMR Escherichia coli (E. coli), Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, and Staphylococcus aureus infections.

Setting:

Australian public hospitals.

Findings:

Australian hospitals spent an additional AUD$5.8 million (95% uncertainty interval [UI], $2.2–$11.2 million) per year treating ceftriaxone-resistant E.coli bloodstream infections (BSI), and an estimated AUD$5.5 million per year (95% UI, $339,633–$22.7 million) treating MRSA patients. There are no reliable estimates of excess morbidity and mortality from AMR infections in sites other than the blood and in particular for highly prevalent AMR E. coli causing urinary tract infections (UTIs).

Conclusion:

The limited evidence-base of the health impact of resistant infection in UTIs limits economic studies estimating the overall burden of AMR. Such data are increasingly important and are urgently needed to support local clinical practice as well as national and global efforts to curb the spread of AMR.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 320 - 327
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

Press release: High-level meeting on antimicrobial resistance. World Health Organization website. http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/. Published September 21, 2016. Accessed January 9, 2019.Google Scholar
Australian Department of Health. National Antimicrobial Resistance Strategy 2015–2019. Canberra: Australian Department of Health; 2015.Google Scholar
Wozniak, TM, Paterson, D, Halton, K. Review of the epidemiological data regarding antimicrobial resistance in gram-negative bacteria in Australia. Infect Dis Health 2017;22:8.Google Scholar
Gandra, S, Barter, DM, Laxminarayan, R. Economic burden of antibiotic resistance: how much do we really know? Clin Microbiol Infect 2014;20:973–980.10.1111/1469-0691.12798CrossRefGoogle ScholarPubMed
Graves, N, Harbarth, S, Beyersmann, J, Barnett, A, Halton, K, Cooper, B. Estimating the cost of health care-associated infections: mind your p’s and q’s. Clin Infect Dis 2010;50:1017–1021.10.1086/651110CrossRefGoogle ScholarPubMed
De Angelis, G, Murthy, A, Beyersmann, J, Harbarth, S. Estimating the impact of healthcare-associated infections on length of stay and costs. Clin Microbiol Infect 2010;16:1729–1735.CrossRefGoogle ScholarPubMed
Smith, R, Coast, J. The Economic Burden of Antimicrobial Resistance: why it is More Serious than Current Studies Suggest. London: London School of Hygiene and Tropical Medicine; 2012.Google Scholar
Roberts, RR, Hota, B, Ahmad, I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis 2009;49:1175–1184.10.1086/605630CrossRefGoogle Scholar
Smith, RD, Yago, M, Millar, M, Coast, J. Assessing the macroeconomic impact of a healthcare problem: the application of computable general equilibrium analysis to antimicrobial resistance. J Health Econ 2005;24:1055–1075.10.1016/j.jhealeco.2005.02.003CrossRefGoogle ScholarPubMed
O’Neill, J. Review on antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance website. https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf. Published 2014. Accessed January 9, 2019.Google Scholar
de Kraker, ME, Stewardson, AJ, Harbarth, S. Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med 2016;13:e1002184.CrossRefGoogle Scholar
Gram Negative Sepsis Outcome Programme (GNSOP). 2015 antimicrobial susceptibility report. Australian Group on Antimicrobial Resistance (AGAR) website. http://agargroup.org.au/wp-content/uploads/2017/08/July.2016.AGAR-GNSOP-2015-Report-FINAL.pdf. Published 2016. Accessed January 9, 2019.Google Scholar
Stewardson, AJ, Allignol, A, Beyersmann, J, et al. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Euro Surveill 2016;21(33):pii=30319. doi: 10.2807/1560-7917.ES.2016.21.33.30319.CrossRefGoogle ScholarPubMed
Lambert, ML, Suetens, C, Savey, A, et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect Dis 2011;11:30–38.CrossRefGoogle ScholarPubMed
Coombs, GW, Pearson, JC, Le, T, et al. Australian Enterococcal Sepsis Outcome Progamme, 2015. Commun Dis Intell Qtrly Rept 2015;38:E247–E252.Google Scholar
Cheah, AL, Spelman, T, Liew, D, et al. Enterococcal bacteremia: factors influencing mortality, length of stay and costs of hospitalization. Clin Microbiol Infect 2013;19:E181–E189.10.1111/1469-0691.12132CrossRefGoogle ScholarPubMed
Salgado, CD, Farr, BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003;24:690–698.10.1086/502271CrossRefGoogle ScholarPubMed
Australian Staphylococcal Sepsis Outcome Program (ASSOP) 2015: final report. Australian Group on Antimicrobial Resistance (AGAR) website. http://agargroup.org.au/wp-content/uploads/2017/08/July.2016.ASSOP-2015-Final-Report-2016-1.pdf. Published 2016. Accessed January 9, 2019.Google Scholar
Bowman, KO, Shenton, LR. Methods of Moments. Encyclopedia of Statistical Sciences, 2nd ed. John Wiley & Sons; 1985: 467–473.Google Scholar
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.10.1016/j.ajic.2008.03.002CrossRefGoogle ScholarPubMed
Australian Institute of Health and Welfare. Hospital Resources 2013–14: Australian Hospital Statistics. Health Services Series no. 63. Cat. no. HSE 160. Canberra: Australian Institute of Health and Welfare; 2015.Google Scholar
Barnett, AG, Beyersmann, J, Allignol, A, Rosenthal, VD, Graves, N, Wolkewitz, M. The time-dependent bias and its effect on extra length of stay due to nosocomial infection. Value Health 2011;14:381–386.CrossRefGoogle ScholarPubMed
Wozniak, TM. Clinical management of drug-resistant bacteria in Australian hospitals: an online survey of doctors’ opinions. Infect Dis Health 2018;23:41–48.10.1016/j.idh.2017.11.003CrossRefGoogle ScholarPubMed
Antibiotic Expert Groups eTG complete. Therapeutic Guidelines: antibiotic, version 15. Therapeutic Guidelines Limited website. https://tgldcdp.tg.org.au/etgcomplete. Published 2016. Accessed January 9, 2019.Google Scholar
Independent Hospital Pricing Authority Annual Report 2014–15. Independent Hospital Pricing Authority (IHPA) website. https://www.ihpa.gov.au/publications/annual-report-2014-15. Published 2015. Accessed January 9, 2019.Google Scholar
A comprehensive integrated surveillance program to improve Australia’s response to antimicrobial resistance. Expert Advisory Group on Antimicrobial Resistance website. http://agargroup.org.au/wp-content/uploads/2017/08/EAGAR-Report-2006.pdf. Published 2006. Accessed January 9, 2019.Google Scholar
Mitchell, BG, Ferguson, JK, Anderson, M, Sear, J, Barnett, A. Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. J Hosp Infect 2016;93:92–99.CrossRefGoogle ScholarPubMed
Briggs, A, Sculpher, M, Buxton, M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 1994;3:95–104.CrossRefGoogle ScholarPubMed
Staphylococcus aureus bacteraemia in Australian public hospitals 2014–15. Australian Institute of Health and Welfare (AIHW) website. https://www.aihw.gov.au/reports/hospitals/staphylococcus-aureus-bacteraemia-in-australian-pu-1/contents/table–of-contents. Published 2015. Accessed January 9, 2019.Google Scholar
de Kraker, ME, Jarlier, V, Monen, JC, Heuer, OE, van de Sande, N, Grundmann, H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;19:860–868.CrossRefGoogle ScholarPubMed
Wozniak, TM, Graves, N, Barnett, AG. How much do superbugs cost Australian hospitals? an evidence-based open-access tool. Infect Dis Health 2018;23:2.Google ScholarPubMed