Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Site
2.2. Study Design and Patients
2.3. Data Collection
2.4. Propensity Score Matching
2.5. Indicators and Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Before PSM | After PSM for Potential Confounding Variables Excluding LOS Before Culture | After PSM for Potential Confounding Variables Including LOS Before Culture | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline Characteristics | 3GCSEC | 3GCREC | p Value | 3GCSKP | 3GCRKP | P Value | 3GCSEC | 3GCREC | p Value | 3GCSKP | 3GCRKP | p Value | 3GCSEC | 3GCREC | P Value | 3GCSKP | 3GCRKP | p Value |
Number of inpatient, n | 2588 | 2056 | 3485 | 1679 | 1815 | 1815 | 1617 | 1617 | 1804 | 1804 | 1521 | 1521 | ||||||
Age in years, median (range) | 73 (0–100) | 72 (0–100) | 0.196 | 72 (0–100) | 74 (0–99) | <0.000 | 72 (0–100) | 72 (0–100) | 0.233 | 71 (0–100) | 74 (0–99) | 0.465 | 72 (0–100) | 73 (0–100) | 0.843 | 73 (0–99) | 70 (0–99) | 0.396 |
Sex male, n (%) | 1174 (45.36) | 600 (29.18) | <0.000 | 2357 (67.63) | 1163 (69.27) | 0.238 | 585 (32.23) | 600 (33.06) | 0.595 | 1123 (69.45) | 1113 (68.83) | 0.703 | 600 (33.26) | 582 (32.26) | 0.523 | 1052 (69.17) | 1072 (70.48) | 0.43 |
Insurance, n (%) | 2262 (87.40) | 1799 (87.50) | 0.921 | 2859 (82.04) | 1374 (81.83) | 0.859 | 1583 (87.22) | 1590 (87.60) | 0.726 | 1305 (80.71) | 1320 (81.63) | 0.5 | 1582 (87.69) | 1567 (86.86) | 0.454 | 1241 (81.59) | 1224 (80.47) | 0.432 |
Number of diagnoses, median (range) | 6 (1–23) | 6 (1–20) | 0.452 | 6 (1–30) | 7 (1–23) | <0.000 | 6 (1–23) | 6 (1–20) | 0.87 | 7 (1–30) | 6 (1–21) | 0.353 | 6 (1–20) | 6 (1–23) | 0.753 | 7 (1–23) | 6 (1–30) | 0.687 |
Charlson comorbidity index, median (range) | 5 (1–29) | 5 (1–37) | 0.654 | 5 (1–34) | 5 (1–30) | 0.603 | 5 (1–29) | 5 (1–37) | 0.722 | 5 (1–34) | 5 (1–30) | 0.654 | 5 (1–37) | 5 (1–28) | 0.902 | 5 (1–30) | 5 (1–27) | 0.180 |
Admission to ICU, n (%) | 175 (6.76) | 87 (4.23) | <0.000 | 420 (12.05) | 404 (24.06) | <0.000 | 88 (4.85) | 87 (4.79) | 0.938 | 348 (21.52) | 357 (22.08) | 0.701 | 87 (4.82) | 90 (4.99) | 0.817 | 317 (20.84) | 332 (21.83) | 0.507 |
Surgery, n (%) | 770 (29.75) | 451 (21.94) | <0.000 | 868 (24.91) | 514 (30.61) | <0.000 | 464 (25.56) | 447 (24.63) | 0.515 | 498 (30.80) | 490 (30.30) | 0.76 | 448 (24.83) | 445 (24.67) | 0.908 | 459 (30.18) | 496 (32.61) | 0.148 |
Myocardial infarction, n (%) | 63 (2.43) | 47 (2.29) | 0.741 | 102 (2.93) | 41 (2.44) | 0.32 | 44 (2.42) | 43 (2.37) | 0.914 | 40 (2.47) | 41 (2.54) | 0.91 | 44 (2.44) | 37 (2.05) | 0.431 | 34 (2.24) | 41 (2.70) | 0.413 |
Congestive heart failure, n (%) | 439 (16.96) | 296 (14.40) | 0.017 | 627 (17.99) | 258 (15.37) | 0.019 | 283 (15.59) | 293 (16.14) | 0.65 | 229 (14.16) | 248 (15.34) | 0.346 | 296 (16.41) | 279 (15.47) | 0.439 | 235 (15.45) | 220 (14.46) | 0.446 |
Peripheral vascular disease, n (%) | 19 (0.73) | 14 (0.68) | 0.83 | 47 (1.35) | 18 (1.07) | 0.404 | 13 (0.72) | 14 (0.77) | 0.847 | 18 (1.11) | 18 (1.11) | 1 | 14 (0.78) | 18 (1.00) | 0.478 | 18 (1.18) | 21 (1.38) | 0.629 |
Cerebrovascular diseases, n (%) | 1077 (41.62) | 960 (46.69) | 0.001 | 1786 (51.25) | 881 (52.47) | 0.41 | 783 (43.14) | 813 (44.79) | 0.316 | 840 (51.95) | 845 (52.26) | 0.86 | 794 (44.01) | 785 (43.51) | 0.763 | 790 (51.94) | 787 (51.74) | 0.913 |
Dementia, n (%) | 91 (3.52) | 74 (3.60) | 0.879 | 81 (2.32) | 73 (4.35) | <0.000 | 62 (3.42) | 68 (3.75) | 0.592 | 69 (4.27) | 67 (4.14) | 0.861 | 67 (3.71) | 67 (3.71) | 1 | 61 (4.01) | 65 (4.27) | 0.716 |
Chronic pulmonary disease, n (%) | 442 (17.08) | 261 (12.69) | <0.000 | 891 (25.57) | 351 (20.91) | <0.000 | 266 (14.66) | 259 (14.27) | 0.741 | 328 (20.28) | 344 (21.27) | 0.488 | 260 (14.41) | 264 (14.63) | 0.85 | 323 (21.24) | 303 (19.92) | 0.37 |
Connective tissue disease, n (%) | 84 (3.25) | 88 (4.28) | 0.064 | 62 (1.78) | 29 (1.73) | 0.894 | 73 (4.02) | 74 (4.08) | 0.933 | 30 (1.86) | 28 (1.73) | 0.791 | 77 (4.27) | 73 (4.05) | 0.739 | 28 (1.84) | 29 (1.91) | 0.894 |
Mild liver disease, n (%) | 121 (4.68) | 114 (5.54) | 0.179 | 124 (3.56) | 65 (3.87) | 0.574 | 92 (5.07) | 88 (4.85) | 0.76 | 63 (3.90) | 64 (3.96) | 0.928 | 91 (5.04) | 94 (5.21) | 0.821 | 58 (3.81) | 67 (4.40) | 0.411 |
Peptic ulcer disease, n (%) | 62 (2.40) | 57 (2.77) | 0.42 | 105 (3.01) | 55 (3.28) | 0.61 | 48 (2.64) | 45 (2.48) | 0.753 | 53 (3.28) | 52 (3.22) | 0.921 | 48 (2.66) | 49 (2.72) | 0.918 | 49 (3.22) | 53 (3.48) | 0.687 |
Diabetes mellitus, n (%) | 894 (34.54) | 706 (34.34) | 0.884 | 952 (27.32) | 448 (26.68) | 0.631 | 628 (34.60) | 630 (34.71) | 0.944 | 401 (24.80) | 434 (26.84) | 0.185 | 633 (35.09) | 625 (34.65) | 0.78 | 411 (27.02) | 409 (26.89) | 0.935 |
Diabetes mellitus with chronic complications, n (%) | 132 (5.10) | 167 (8.12) | <0.000 | 115 (3.30) | 63 (3.75) | 0.404 | 119 (6.56) | 93 (5.12) | 0.066 | 59 (3.65) | 61 (3.77) | 0.852 | 97 (5.38) | 121 (6.71) | 0.094 | 57 (3.75) | 55 (3.62) | 0.847 |
Moderate to severe chronic kidney disease, n (%) | 232 (8.96) | 188 (9.14) | 0.832 | 235 (6.74) | 189 (11.26) | <0.000 | 171 (9.42) | 166 (9.15) | 0.775 | 176 (10.88) | 165 (10.20) | 0.529 | 166 (9.20) | 167 (9.26) | 0.954 | 153 (10.06) | 165 (10.85) | 0.477 |
Hemiplegia, n (%) | 33 (1.28) | 22 (1.07) | 0.521 | 24 (0.69) | 22 (1.31) | 0.026 | 18 (0.99) | 21 (1.16) | 0.629 | 24 (1.48) | 20 (1.24) | 0.544 | 21 (1.16) | 19 (1.05) | 0.75 | 18 (1.18) | 20 (1.31) | 0.744 |
Solid tumor without metastases, n (%) | 316 (12.21) | 207 (10.07) | 0.022 | 224 (6.43) | 126 (7.50) | 0.149 | 198 (10.91) | 204 (11.24) | 0.751 | 128 (7.92) | 124 (7.67) | 0.793 | 206 (11.42) | 197 (10.92) | 0.634 | 121 (7.96) | 126 (8.28) | 0.74 |
Leukemia, n (%) | 40 (1.55) | 21 (1.02) | 0.119 | 51 (1.46) | 40 (2.38) | 0.019 | 22 (1.21) | 21 (1.16) | 0.878 | 43 (2.66) | 38 (2.35) | 0.574 | 21 (1.16) | 19 (1.05) | 0.75 | 35 (2.30) | 39 (2.56) | 0.638 |
Malignant lymphoma, n (%) | 34 (1.31) | 12 (0.58) | 0.013 | 33 (0.95) | 28 (1.67) | 0.025 | 8 (0.44) | 12 (0.66) | 0.37 | 27 (1.67) | 25 (1.55) | 0.78 | 12 (0.67) | 13 (0.72) | 0.841 | 24 (1.58) | 30 (1.97) | 0.41 |
Severe liver disease, n (%) | 52 (2.01) | 33 (1.61) | 0.307 | 45 (1.29) | 26 (1.55) | 0.457 | 29 (1.60) | 32 (1.76) | 0.698 | 27 (1.67) | 26 (1.61) | 0.89 | 32 (1.77) | 33 (1.83) | 0.9 | 23 (1.51) | 23 (1.51) | 1.000 |
Metastatic tumor, n (%) | 129 (4.98) | 112 (5.45) | 0.48 | 206 (5.91) | 59 (3.51) | <0.000 | 99 (5.45) | 88 (4.85) | 0.409 | 70 (4.33) | 59 (3.65) | 0.323 | 91 (5.04) | 97 (5.38) | 0.653 | 58 (3.81) | 40 (2.63) | 0.065 |
Confounding Variables | Hospital Cost ($) | 3GCSEC | 3GCREC | Difference | p Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Median | 95% CI | Median | 95% CI | Median | 95% CI | ||||||
Excluding LOS before culture | Total hospital cost | 3867 | 3558 | 4185 | 5233 | 4737 | 5638 | 1366 | 1179 | 1453 | <0.000 |
Antibiotic cost | 126 | 99 | 143 | 278 | 246 | 311 | 152 | 146 | 168 | <0.000 | |
Medication cost | 1418 | 1286 | 1563 | 2045 | 1863 | 2279 | 627 | 577 | 715 | <0.000 | |
Diagnostic cost | 873 | 844 | 914 | 955 | 901 | 992 | 81 | 57 | 79 | <0.000 | |
Treatment cost | 778 | 719 | 858 | 1142 | 1043 | 1250 | 363 | 324 | 393 | <0.000 | |
Material cost | 187 | 160 | 225 | 321 | 289 | 368 | 134 | 129 | 143 | <0.000 | |
Other costs | 8 | 8 | 9 | 9 | 8 | 10 | 1 | 0 | 1 | 0.003 | |
Including LOS before culture | Total hospital cost | 4057 | 3791 | 4435 | 5197 | 4733 | 5662 | 1140 | 942 | 1227 | <0.000 |
Antibiotic cost | 132 | 108 | 150 | 260 | 235 | 297 | 127 | 127 | 147 | <0.000 | |
Medication cost | 1522 | 1385 | 1689 | 2037 | 1840 | 2281 | 515 | 456 | 592 | <0.000 | |
Diagnostic cost | 886 | 848 | 916 | 953 | 909 | 1002 | 67 | 61 | 85 | <0.000 | |
Treatment cost | 841 | 773 | 934 | 1111 | 1018 | 712 | 271 | 245 | 296 | <0.000 | |
Material cost | 199 | 172 | 238 | 306 | 273 | 352 | 107 | 101 | 114 | <0.000 | |
Other costs | 8 | 7 | 9 | 9 | 8 | 10 | 1 | 1 | 1 | 0.0213 |
Potential Confounding Variables | Hospital Cost ($) | 3GCSKP | 3GCRKP | Difference | p Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Median | 95% CI | Median | 95% CI | Median | 95% CI | ||||||
Excluding LOS before culture | Total hospital cost | 8084 | 7380 | 9029 | 15,754 | 14,799 | 16,961 | 7671 | 7419 | 7932 | <0.000 |
Antibiotic cost | 490 | 430 | 538 | 1372 | 1239 | 1521 | 881 | 809 | 982 | <0.000 | |
Medication cost | 3461 | 3122 | 3781 | 7923 | 7290 | 8439 | 4461 | 4168 | 4658 | <0.000 | |
Diagnostic cost | 1397 | 1332 | 1472 | 2017 | 1898 | 2180 | 620 | 566 | 708 | <0.000 | |
Treatment cost | 1637 | 1491 | 1768 | 3249 | 2992 | 3524 | 1612 | 1501 | 1756 | <0.000 | |
Material cost | 472 | 419 | 536 | 1055 | 954 | 1177 | 583 | 535 | 641 | <0.000 | |
Other costs | 14 | 12 | 16 | 17 | 15 | 20 | 3 | 3 | 4 | 0.079 | |
Including LOS before culture | Total hospital cost | 9699 | 9089 | 10,537 | 14,463 | 13,428 | 15,561 | 4763 | 4340 | 5025 | <0.000 |
Antibiotic cost | 526 | 467 | 590 | 1255 | 1122 | 1404 | 729 | 655 | 814 | <0.000 | |
Medication cost | 4166 | 3811 | 4571 | 7164 | 6506 | 7881 | 2998 | 2695 | 3310 | <0.000 | |
Diagnostic cost | 1452 | 1380 | 1554 | 1896 | 1761 | 2014 | 445 | 380 | 460 | <0.000 | |
Treatment cost | 2043 | 1831 | 2240 | 2995 | 2820 | 3255 | 952 | 989 | 1015 | <0.000 | |
Material cost | 623 | 566 | 689 | 963 | 866 | 1071 | 340 | 299 | 383 | <0.000 | |
Other costs | 16 | 14 | 18 | 16 | 14 | 19 | 0 | 1 | 1 | 0.4680 |
Potential Confounding Variables | LOS (Days) | Third-Generation Cephalosporins-Susceptible | Third-Generation Cephalosporins-Resistant | Difference | p Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Median | 95% CI | Median | 95% CI | Median | 95% CI | ||||||
Excluding LOS before culture | 3GCREC vs. 3GCSEC | 16 | 16 | 17 | 20 | 19 | 21 | 4 | 3 | 4 | <0.000 |
3GCRKP vs. 3GCSKP | 20 | 19 | 21 | 31 | 30 | 32 | 11 | 11 | 11 | <0.000 | |
Including LOS before culture | 3GCREC vs. 3GCSEC | 17 | 16 | 17 | 19.5 | 18 | 21 | 2.5 | 2 | 4 | <0.000 |
3GCRKP vs. 3GCSKP | 23 | 22 | 24 | 30 | 29 | 31 | 7 | 7 | 7 | <0.000 |
Potential Confounding Variables | Mortality Rate (%) | Third-Generation Cephalosporins-Susceptible | Third-Generation Cephalosporins-Resistant | Difference | p Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Rate | 95% CI | Rate | 95% CI | Rate | 95% CI | ||||||
Excluding LOS before culture | 3GCREC vs. 3GCSEC | 2.15 | 1.58 | 2.93 | 2.7 | 2.05 | 3.55 | 0.55 | 0.47 | 0.62 | 0.281 |
3GCRKP vs. 3GCSKP | 3.65 | 2.84 | 4.68 | 6.74 | 5.62 | 8.07 | 3.09 | 2.78 | 3.39 | <0.000 | |
Including LOS before culture | 3GCREC vs. 3GCSEC | 2.16 | 1.58 | 2.94 | 2.49 | 1.87 | 3.32 | 0.33 | 0.29 | 0.38 | 0.508 |
3GCRKP vs. 3GCSKP | 3.81 | 2.96 | 4.89 | 6.51 | 5.35 | 7.9 | 2.7 | 2.39 | 3.01 | 0.001 |
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Zhen, X.; Stålsby Lundborg, C.; Sun, X.; Hu, X.; Dong, H. Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China. Int. J. Environ. Res. Public Health 2020, 17, 9285. https://doi.org/10.3390/ijerph17249285
Zhen X, Stålsby Lundborg C, Sun X, Hu X, Dong H. Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China. International Journal of Environmental Research and Public Health. 2020; 17(24):9285. https://doi.org/10.3390/ijerph17249285
Chicago/Turabian StyleZhen, Xuemei, Cecilia Stålsby Lundborg, Xueshan Sun, Xiaoqian Hu, and Hengjin Dong. 2020. "Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China" International Journal of Environmental Research and Public Health 17, no. 24: 9285. https://doi.org/10.3390/ijerph17249285