Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji

被引:6
作者
Loftus, Michael J. [1 ,2 ]
Young-Sharma, Tracey E. M. W. [3 ]
Lee, Sue J. [1 ,2 ]
Wati, Shitanjni [3 ]
Badoordeen, Gnei Z. [1 ,2 ]
Blakeway, Luke V. [1 ,2 ]
Byers, Sally M. H. [1 ,2 ]
Cheng, Allen C. [1 ,2 ,4 ]
Cooper, Ben S. [5 ,6 ]
Cottingham, Hugh [1 ,2 ]
Jenney, Adam W. J. [1 ,2 ,7 ]
Hawkey, Jane [1 ,2 ]
Macesic, Nenad [1 ,2 ,8 ]
Naidu, Ravi [3 ]
Prasad, Amitesh [3 ]
Prasad, Vinita [3 ]
Tudravu, Litia [3 ]
Vakatawa, Timoci [3 ]
Van Gorp, Elke [1 ,2 ]
Wisniewski, Jessica A. [1 ,2 ]
Rafai, Eric [9 ]
Peleg, Anton Y. [1 ,2 ,10 ]
Stewardson, Andrew J. [1 ,2 ]
机构
[1] Monash Univ, Cent Clin Sch, Melbourne, Australia
[2] Monash Univ, Alfred Hosp, Dept Infect Dis, Melbourne, Australia
[3] Colonial War Mem Hosp, Suva, Fiji
[4] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Australia
[5] Univ Oxford, Nuffield Dept Med, Ctr Trop Med & Global Hlth, Oxford, England
[6] Mahidol Univ, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand
[7] Fiji Natl Univ, Suva, Fiji
[8] Monash Univ, Ctr Impact AMR, Melbourne, Australia
[9] Fiji Minist Hlth & Med Serv Suva Fiji, Suva, Fiji
[10] Monash Univ, Monash Biomedicine Discovery Inst, Dept Microbiol, Infect & Immun Program, Clayton, Vic, Australia
基金
英国惠康基金; 英国医学研究理事会;
关键词
Bloodstream infection; Enterobacterales; Mortality; Antimicrobial resistance; Fiji;
D O I
10.1016/j.jgar.2022.06.016
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji. Methods: We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and we used multistate modelling to estimate the excess length of hospital stay. Results: From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs; 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio [aHR] 1.13, 95% confidence interval [CI] 0.51-2.53) or being discharged alive (aHR 0.99, 95% CI 0.65-1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36-1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31-9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5-2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission. Conclusion: Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality. (C) 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.
引用
收藏
页码:286 / 293
页数:8
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