Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Yunying Zhu; Tingting Xiao; Yuan Wang; Kai Yang; Yanzi Zhou; Qixia Luo; Ping Shen; Yonghong Xiao

doi:10.2147/IDR.S341664

Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Infect Drug Resist. 2021 Dec 14:14:5385-5393. doi: 10.2147/IDR.S341664. eCollection 2021.

Authors

Yunying Zhu^#¹, Tingting Xiao^#¹, Yuan Wang¹, Kai Yang¹, Yanzi Zhou¹, Qixia Luo¹, Ping Shen¹, Yonghong Xiao¹

Affiliation

¹ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China.

^# Contributed equally.

Abstract

Background: Although infection with carbapenem-resistant Enterobacteriaceae (CRE) has become an urgent public health threat worldwide, the socioeconomic burden of CRE bloodstream infection (BSI) remains to be clarified.

Methods: This retrospective study included all patients infected with Escherichia coli or Klebsiella pneumoniae who were hospitalized for BSI from 2013 to 2015. Socioeconomic burden, including direct and indirect economic burden, was compared in patients infected with carbapenem-sensitive Enterobacteriaceae (CSE) and CRE following 1:1 propensity score matching (PSM) to control for confounding variables.

Results: Data from 879 patients with Enterobacteriaceae BSI were evaluated, including 152 (17.3%) patients infected with CRE and 727 (82.7%) infected with CSE. PSM yielded 112 pairs of 224 patients. Median hospital length of stay did not differ significantly in the CRE and CSE groups (35 vs 29 days, P = 0.089), but in-hospital 28-day mortality rate was significantly higher in patients infected with CRE than with CSE (45.5% vs 32.1%, P = 0.040). Median direct economic burden was significantly greater in patients with CRE-BSI than with CSE-BSI during hospitalization ($24,940.1 vs 16,864.0, P = 0.017) but not during the period after infection ($10,403.4 vs 8498.0, P = 0.178). Drug expenditure accounted for the largest proportion of costs in both groups. The median disability-adjusted life year (DALY) was higher in CRE-BSI than in CSE-BSI patients, but the difference was not statistically significant (7.9 vs 6.7 years, P = 0.190). Median indirect economic burden did not differ significantly in these two groups ($3848.5 vs 1139.9, P = 0.304), although indirect economic burden increased significantly from 2013 to 2015 in patients with CRE-BSI.

Conclusion: Carbapenem resistance had a major impact on the clinical and socioeconomic burden of patients with Enterobacteriaceae BSI. The higher mortality rate in patients with CRE-BSI was associated with increased direct healthcare burden and indirect socioeconomic loss.

Keywords: Enterobacteriaceae; Escherichia coli; Klebsiella pneumonia; carbapenem resistant; disability-adjusted life years; socioeconomic burden.

Grants and funding

This work was partially supported by grants from The National Key Research and Development Program of China (2017YFC1200203), the National Natural Science Foundation of China (81971984) and Investigator Initiated Studies (IIS) Clinical Status Update Report IISP #(58449).