Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe

Marlieke E A de Kraker, Peter G Davey, Hajo Grundmann, BURDEN study group, Walter Koller, Jutta Berger, Jan Nagler, Claudine Icket, Smilja Kalenic, Jasminka Horvatic, Harald Seifert, Achim Kaasch, Olga Paniara, Athina Argyropoulou, Maria Bompola, Edmond Smyth, Mairead Skally, Annibale Raglio, Uga Dumpis, Agita Melbarde-Kelmere, Michael Borg, Debby Xuereb, Mihaela Camelia Ghita, Michelle Noble, Jana Kolman, Stanko Grabljevec, David Turner, Louise Lansbury, Marlieke E A de Kraker, Peter G Davey, Hajo Grundmann, BURDEN study group, Walter Koller, Jutta Berger, Jan Nagler, Claudine Icket, Smilja Kalenic, Jasminka Horvatic, Harald Seifert, Achim Kaasch, Olga Paniara, Athina Argyropoulou, Maria Bompola, Edmond Smyth, Mairead Skally, Annibale Raglio, Uga Dumpis, Agita Melbarde-Kelmere, Michael Borg, Debby Xuereb, Mihaela Camelia Ghita, Michelle Noble, Jana Kolman, Stanko Grabljevec, David Turner, Louise Lansbury

Abstract

Background: The relative importance of human diseases is conventionally assessed by cause-specific mortality, morbidity, and economic impact. Current estimates for infections caused by antibiotic-resistant bacteria are not sufficiently supported by quantitative empirical data. This study determined the excess number of deaths, bed-days, and hospital costs associated with blood stream infections (BSIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and third-generation cephalosporin-resistant Escherichia coli (G3CREC) in 31 countries that participated in the European Antimicrobial Resistance Surveillance System (EARSS).

Methods and findings: The number of BSIs caused by MRSA and G3CREC was extrapolated from EARSS prevalence data and national health care statistics. Prospective cohort studies, carried out in hospitals participating in EARSS in 2007, provided the parameters for estimating the excess 30-d mortality and hospital stay associated with BSIs caused by either MRSA or G3CREC. Hospital expenditure was derived from a publicly available cost model. Trends established by EARSS were used to determine the trajectories for MRSA and G3CREC prevalence until 2015. In 2007, 27,711 episodes of MRSA BSIs were associated with 5,503 excess deaths and 255,683 excess hospital days in the participating countries, whereas 15,183 episodes of G3CREC BSIs were associated with 2,712 excess deaths and 120,065 extra hospital days. The total costs attributable to excess hospital stays for MRSA and G3CREC BSIs were 44.0 and 18.1 million Euros (63.1 and 29.7 million international dollars), respectively. Based on prevailing trends, the number of BSIs caused by G3CREC is likely to rapidly increase, outnumbering the number of MRSA BSIs in the near future.

Conclusions: Excess mortality associated with BSIs caused by MRSA and G3CREC is significant, and the prolongation of hospital stay imposes a considerable burden on health care systems. A foreseeable shift in the burden of antibiotic resistance from Gram-positive to Gram-negative infections will exacerbate this situation and is reason for concern.

Conflict of interest statement

All authors have read the journal's policy and HG and MdK have declared that they have no competing interests. PD has the following conflicts, he has received support for research projects about the management of infection from Janssen Cilag and about the epidemiology of asthma from Glaxo Smith Kline. He has been a member of an Advisory Board on antimicrobial resistance for Wyeth and an Advisory Board about new antibiotics for Johnson and Johnson. He has received speaker fees and support to attend meetings from Johnson & Johnson and Optimer Pharmaceuticals.

Figures

Figure 1. Trends in the estimated number…
Figure 1. Trends in the estimated number of MRSA and G3CREC bacteremias in the European region.
Extrapolated EARSS numbers for 2003–2009, and future trajectories based on regression analysis for 2010–2015.

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Source: PubMed

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