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Title: Burden of antimicrobial resistance in European hospitals : excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins
Authors: Borg, Michael Angelo
Xuereb, Deborah
Kraker, M. E. A. de
Wolkewitz, Martin
Davey, Peter Garnet
Koller, Waltraud
Berger, Jutta
Nagler, Jan M.
Icket, Claudine
Kalenić, Smilja
Horvatić, Jasminka
Seifert, Harald
Kaasch, Achim J.
Paniara, Olga l.
Argyropoulou, Athina D.
Bompola, Maria
Smyth, Edmond G.
Skally, Máiréad
Raglio, Annibale
Dumpis, U.
Kelmere, Agita Melbarde
Ghita, Mihaela Camelia
Noble, Michelle
Kolman, Jana
Grabljevec, Stanko
Turner, David P. J.
Lansbury, Louise
Grundmann, Hajo J.
Keywords: Antibiotics -- Effectiveness -- Europe
Drug resistance in microorganisms
Escherichia coli -- Europe
Hospital mortality
Issue Date: 2011
Publisher: Oxford University Press
Citation: De Kraker, M. E. A., Wolkewitz, M., Davey, P. G., Koller, W., Berger, J., Nagler, J.,...Grundmann, H. (2011). Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins. Journal of Antimicrobial Chemotherapy, 66(2), 398-407.
Abstract: Objectives: This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe. Methods: A prospective parallel matched cohort design was used. Cohort I consisted of patients with thirdgeneration-cephalosporin-resistant E. coli BSI (REC) and cohort II consisted of patients with third-generationcephalosporin-susceptible E. coli BSI (SEC). Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI. Thirteen European tertiary care centres participated between July 2007 and June 2008. Results: Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls. REC patients had a higher mortality at 30 days (adjusted odds ratio=4.6) and a higher hospital mortality (adjusted hazard ratio=5.7) than their controls. LOS was increased by 8 days. For SEC patients, these figures were adjusted odds ratio=1.9, adjusted hazard ratio=2.0 and excess LOS=3 days. A 2.5 times [95% confidence interval (95% CI) 0.9-6.8] increase in all-cause mortality at 30 days and a 2.9 times (95% CI 1.2-6.9) increase in mortality during entire hospital stay as well as an excess LOS of 5 days (95% CI 0.4-10.2) could be attributed to resistance to third-generation cephalosporins in E. coli BSI. Conclusions: Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant. If prevailing resistance trends continue, high societal and economic costs can be expected. Better management of infections caused by resistant E. coli is becoming essential.
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