Clinical and economic outcomes attributable to carbapenem-resistant Enterobacterales and delayed appropriate antibiotic therapy in hospitalized patients

2021 ◽  
pp. 1-11
Author(s):  
Kirati Kengkla ◽  
Yuttana Wongsalap ◽  
Natthaya Chaomuang ◽  
Pichaya Suthipinijtham ◽  
Peninnah Oberdorfer ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Mortality Rates ◽  
Hospitalized Patients ◽  
Economic Outcomes ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Medication Costs ◽  
The Impact

Abstract Objective: To assess the impact of carbapenem resistance and delayed appropriate antibiotic therapy (DAAT) on clinical and economic outcomes among patients with Enterobacterales infection. Methods: This retrospective cohort study was conducted in a tertiary-care medical center in Thailand. Hospitalized patients with Enterobacterales infection were included. Infections were classified as carbapenem-resistant Enterobacterales (CRE) or carbapenem-susceptible Enterobacterales (CSE). Multivariate Cox proportional hazard modeling was used to examine the association between CRE with DAAT and 30-day mortality. Generalized linear models were used to examine length of stay (LOS) and in-hospital costs. Results: In total, 4,509 patients with Enterobacterales infection (age, mean 65.2 ±18.7 years; 43.3% male) were included; 627 patients (13.9%) had CRE infection. Among these CRE patients, 88.2% received DAAT. CRE was associated with additional medication costs of $177 (95% confidence interval [CI], 114–239; P < .001) and additional in-hospital costs of $725 (95% CI, 448–1,002; P < .001). Patients with CRE infections had significantly longer LOS and higher mortality rates than patients with CSE infections: attributable LOS, 7.3 days (95% CI, 5.4–9.1; P < .001) and adjusted hazard ratios (aHR), 1.55 (95% CI, 1.26–1.89; P < .001). CRE with DAAT were associated with significantly longer LOS, higher mortality rates, and in-hospital costs. Conclusion: CRE and DAAT are associated with worse clinical outcomes and higher in-hospital costs among hospitalized patients in a tertiary-care hospital in Thailand.

Clinical and economic impact of oxidized regenerated cellulose for surgeries in a Chinese tertiary care hospital

2020 ◽  
Vol 9 (15) ◽  
pp. 1079-1090
Author(s):  
Zhaoxin Qian ◽  
Fang Xiong ◽  
Xiaozhe Xia ◽  
Pengjuan Gu ◽  
Qinghong Wang ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Regenerated Cellulose ◽  
Care Hospital ◽  
Oxidized Regenerated Cellulose ◽  
Transfusion Volume ◽  
Manual Pressure ◽  
The Impact ◽  
Arthroplasty Surgery

Aim: To assess the impact of oxidized regenerated cellulose (ORC) on blood transfusion and hospital costs associated with surgeries. Patients & methods: This retrospective cohort study selected ten surgeries to create propensity-score matching groups to compare ORC versus nonORC (conventional hemostatic techniques such as manual pressure, ligature and electrocautery). Results: NonORC was associated with both higher blood transfusion volume and higher hospital costs than ORC in endoscopic transnasal sphenoidal surgery, nonskull base craniotomy, hepatectomy, cholangiotomy, gastrectomy and lumbar surgery. However, nonORC was associated with better outcomes than ORC in open colorectal surgery, mammectomy and hip arthroplasty surgery. Conclusion: When compared with conventional hemostatic technique, using ORC could impact blood transfusion and hospital costs differently by surgical settings.

scholarly journals 2035. Clinical and Economic Outcomes in Patients with Complicated Urinary Tract Infection (cUTI) and Complicated Intra-Abdominal Infection (cIAI) in Perú: Impact of Gram-Negative Organisms (GNO) Resistant to Antibiotics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S684-S684
Author(s):  
Luis Hercilla ◽  
Giancarlo Perez ◽  
Ricardo Illescas ◽  
Jose Hidalgo ◽  
Eresvita Ramirez ◽  
...  
Keyword(s):  
Clinical Status ◽  
Tertiary Care ◽  
Complicated Urinary Tract Infection ◽  
Cost Of Care ◽  
Economic Outcomes ◽  
Status Change ◽  
Carbapenem Resistant ◽  
Gram Negative Organisms ◽  
Intra Abdominal Infection ◽  
The Impact

Abstract Background Delays in appropriate therapy of infections affect clinical outcomes. The aim of this study was to compare the clinical and economic outcomes of patients with cUTI and cIAI due to cephalosporin- and carbapenem-resistant GNOs to similar infections caused by nonresistant GNOs. Methods A retrospective cohort study of patients admitted to two tertiary care hospitals in Lima-Callao, Peru between January and December 2017. Patients with resistant strains were compared with those with nonresistant strains for the failure of initial antibiotic regimen (defined as worsened clinical status, change of initial antibiotic treatment, or in-hospital mortality), median length of stay (LOS), hospitalization ward cost and total hospitalization cost. Results A sample of 500 consecutive culture-positive patients were included: 429 (86%) with cUTI and 71 (14%) with cIAI (table). Conclusion cUTI caused by GNOs resistant to cephalosporins or carbapenems are associated with an incremental clinical and economic burden. The proportion of inappropriate therapy in patients with resistant infections is high. The cost of care for carbapenem-resistant cUTI was highest. The appropriate initial antibiotic choice may minimize the impact of GNO resistance on outcomes of patients with cIAI and cUTI. Disclosures All authors: No reported disclosures.

scholarly journals Multimodal Interventions to Prevent and Control Carbapenem-Resistant Enterobacteriaceae and Extended-Spectrum β-Lactamase Producer-Associated Infections at a Tertiary Care Hospital in Egypt

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 509
Author(s):  
Noha A. Kamel ◽  
Khaled M. Elsayed ◽  
Mohamed F. Awad ◽  
Khaled M. Aboshanab ◽  
Mervat I. El Borhamy
Keyword(s):  
Tertiary Care ◽  
Health Care Facilities ◽  
Care Hospital ◽  
Intervention Period ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
The Impact ◽  
Susceptibility Rate ◽  
Esbl Producers ◽  
Carbapenem Resistant Enterobacteriaceae

The current rise of multidrug-resistant (MDR) Gram-negative Enterobacteriaceae including the extended-spectrum β-lactamase (ESBL)-producing organisms and carbapenem-resistant Enterobacteriaceae (CRE) has been increasingly reported worldwide, posing new challenges to health care facilities. Accordingly, we evaluated the impact of multimodal infection control interventions at one of the major tertiary healthcare settings in Egypt for the aim of combating infections by the respective pathogens. During the 6-month pre-intervention period, the incidence rate of CRE and ESBL-producing clinical cultures were 1.3 and 0.8/1000 patient days, respectively. During the post-intervention period, the incidence of CRE and ESBL producers continued to decrease, reaching 0.5 and 0.28/1000 patient days, respectively. The susceptibility rate to carbapenems among ESBL producers ranged from 91.4% (ertapenem) to 98.3% (imipenem), amikacin (93%), gentamicin (56.9%), and tobramycin (46.6%). CRE showed the highest resistance pattern toward all of the tested β-lactams and aminoglycosides, ranging from 87.3% to 94.5%. Both CRE and ESBL producers showed a high susceptibility rate (greater than 85.5%) to colistin and tigecycline. In conclusion, our findings revealed the effectiveness of implementing multidisciplinary approaches in controlling and treating infections elicited by CRE and ESBL producers.

scholarly journals 1038. Impact of an Electronic Antibiotic Timeout on the Utilization of Frequently Prescribed Antibiotics in Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S365
Author(s):  
Ty C Drake ◽  
Chase E Janak ◽  
Kevin W Garey ◽  
Travis J Carlson ◽  
William L Musick ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Costs ◽  
High Volume ◽  
Patient Admission ◽  
Hospitalized Patients ◽  
Resistant Organism ◽  
Care Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Methods to operationalize antibiotic timeouts (ATO) among hospitalized patients are often constrained by the high volume of antibiotic orders that surpass the capabilities of the antimicrobial stewardship program (ASP) to intervene. Houston Methodist Hospital implemented a streamlined electronic ATO process that alerted providers to evaluate the need for continued antibiotics on day 4 of predefined anti-infective therapy. Unresolved alerts were reviewed by clinical pharmacists the following day. The objective of this study was to determine the impact of this electronic ATO on frequently prescribed antibiotics. Methods This was a quasi-experimental study in a 924-bed quaternary care hospital comparing days of therapy (DOT) in patients admitted prior to (February 2017 – January 2018) and after implementing an ATO process (March 2018 – February 2019). Antibiotics evaluated included vancomycin, cefepime, piperacillin/tazobactam, and meropenem. ATO alert logic was simulated retrospectively to capture the pre-ATO cohort. The primary outcome was mean composite DOT per patient admission. Secondary outcomes included total hospitalization cost, Clostridioides difficile infection (CDI) and multidrug-resistant organism (MDRO) rates. Results A total of 8,458 patients met ATO alert criteria for inclusion in the pre-ATO timeframe and 6,901 patients with an ATO alert in the post-ATO group; 2,642 (38%) prompted a pharmacists’ review. The average composite DOT was 11.5 per admission in the pre-ATO cohort compared with 11.1 in the post-ATO cohort (P = 0.02). After multivariate linear regression, the ATO was significantly associated with a decrease of 0.5 DOT per patient admission (P < 0.001). Other factors associated with a reduction in DOT included age (P < 0.001), service line (P = 0.003), and admission source (P = 0.031). Mean hospital costs per admission were significantly reduced in the post-ATO group: $67,613 vs. $66,615 (P = 0.01). There was no difference in rates of CDI and MDRO. Conclusion Implementation of our electronic ATO process demonstrated significant reductions in overall DOT for frequently prescribed antibiotics and decreased total hospital costs across a diverse patient population. This process provides a real-world strategy to operationalize a large-scale ATO as an adjunct to an ASP. Disclosures All authors: No reported disclosures.

scholarly journals Determining the Impact of the Opioid Crisis on a Tertiary-Care Hospital in Central New York to Identify Critical Areas of Intervention in the Local Community

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Sanjay K. Yadava ◽  
Stephen J. Thomas ◽  
Scott Riddell ◽  
Dongliang Wang ◽  
Timothy P. Endy
Keyword(s):  
New York ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Case Fatality ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Opioid Use ◽  
Medical Reason ◽  
Central New York ◽  
The Impact

Background. Central New York has been afflicted by the heroin epidemic with an increase in overdose deaths involving opioids. Objective. The objective of the study was to understand the epidemiology of hospitalizations related to a diagnosis of opioid use (OU). Design. The study was designed as a retrospective analysis of hospitalized patients admitted from January 1, 2008, to December 30, 2018, using ICD-9 and 10 codes for heroin or opiate use, overdose, or poisoning. Setting. The study was conducted in a tertiary-care and teaching hospital located in Central New York. Patients. Hospitalized patients were included as study participants. Results. Opioid use-related admissions increased from .05/100 hospital admissions in 2008 to a peak of 2.9/100 in 2018, a 58-fold increase. There were 49 deaths over the 11-year period for an overall case fatality of 1.2 per 100 OU admissions. The median age for all years was 40 years (SD of 13.7 years), and admissions were largely white caucasians (67.0% of all admissions). The mean length of stay was 8.55 days (SD 12 days), with a range of 1 to 153 days. The most frequent discharge diagnosis was due to infections (15.0% of discharge diagnoses) followed by trauma (5.8% of discharge diagnoses). Methicillin-resistant Staphylococcus aureus was more common in patients with OU (58.1%) than in patients with non-OU (43%) (p<0.0001 by chi-square with Yates’ correction). Spatial analysis was performed by zip code and demonstrated regional hotspots for OU-related admissions. Limitations. The limitations of this study are its retrospective nature and largely numerator-based analysis. The use of ICD codes underrepresents the true burden due to underreporting and failure to code appropriately. This study focuses on patients who are hospitalized for a medical reason with a secondary diagnosis of opioid use and does not include patients who present to the emergency room with an overdose underrepresenting the true burden of the problem. Conclusions. Our results demonstrate the impact of the opioid epidemic in one tertiary-care center and the need to prepare for the costs and resources to address addiction care for this population.

scholarly journals 544. Clonal Spread of Two Sequence Types of Carbapenem-Resistant Acinetobacter baumannii Blood Isolates at a Tertiary Care Hospital in South Korea Over 2.5 Years

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S259-S260
Author(s):  
Seong Eun Kim ◽  
Su-Mi Choi ◽  
Yohan Yu ◽  
Sung un Shin ◽  
Tae hoon Oh ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Mortality Rates ◽  
The Other ◽  
Rank Test ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Log Rank Test ◽  
Clonal Spread

Abstract Background The dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) became an urgent public health concern. A specific sequence type (ST) of A. bauamannii has been reported to be associated with severity of disease or mortality. This study aimed to determine the genetic relatedness of CRAB blood isolates cultured from patients at a tertiary care hospital and to investigate clinical characteristics and outcome of CRAB bacteremia. Methods CRAB blood isolates were collected between June 2016 and December 2018, and their clinical data were obtained. Multi-locus sequence test (MLST) was performed using the Oxford scheme, and the STs were assigned using the MLST database. Results Of the 126 CRAB blood isolates, 123 isolates which could be typed by MLST all belonged to clonal complex (CC) 92. During the entire period, ST369 (42.3%) was the most dominant, followed by ST191 (32.5%), ST784 (13.8%) and ST451 (4.1%). ST369 was firstly introduced in August 2017. ST191 (61.4%) was the most abundant during June 2016 to July 2017, whereas ST369 (65.8%) replaced ST191 (16.5%) since August 2017. The time interval between intensive care unit admission and bacteremia was shorter in ST369 than ST191 in multivariate analysis (day, median (Q1, Q3), ST369 6 (3, 9.8), ST191 9 (6, 17), Odd Ratio 0.87 (95% CI 0.76–0.99) P = 0.048 logistic regression). According to the ST, the 7-day and 30-day mortality rates were as follows; 46% and 65% in ST191, 50% and 62% in ST369, and 10.7% and 46.4% in the other STs. Patients infected by ST191 or 369 had significant higher 7-day mortality rates (ST191/369, 48.3% vs. the other STs 10.7%, P = 0.001 by log-rank test) and 30-day mortality rates (ST191/369, 63.2% vs. the other STs, 46.4%, P = 0.045 by log-rank test). Conclusion This study demonstrates the clonal spread of two STs at a tertiary care hospital in South Korea over 2.5 years. After the introduction of ST369, it replaced ST 191 and widely disseminated within a hospital. Two predominant STs were associated with poor outcome. Continuous surveillance are necessary to monitor the dissemination of these strains. Disclosures All authors: No reported disclosures.

Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

2021 ◽  
Vol 18 (4) ◽  
pp. 429-436
Author(s):  
Santhiya K. ◽  
Jayanthi S. ◽  
Ananthasubramanian M. ◽  
Appalaraju B.
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Medical Science ◽  
Geographical Location ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

Sign in / Sign up

Export Citation Format

Share Document