TABLE 2.
Impact of extended-spectrum cephalosporin resistance in Enterobacteriaceae on mortality, LOS, and hospital cost
| Type of study | Setting | Type of infection | Bacteria | No. of cases/no. of controls | Parameter | Main findings | Significance (P value or 95% CI) | Reference |
|---|---|---|---|---|---|---|---|---|
| Studies showing an impact of resistance | ||||||||
| Case-control | Tertiary care | Nosocomial | E. coli and K. pneumoniae | 33/66a | LOS | Cases, 1.76 times greater duration | 1.17-2.64 | 42 |
| Increased cost | Cases, 2.90 times higher cost | 1.76-4.78 | ||||||
| Case-control | Tertiary care | BSI | K. pneumoniae | 44/118a | LOS | Cases, 39.6 days; controls, 23.9 days | P < 0.008 | 38 |
| Case-control | Multicenter | Nosocomial | K. pneumoniae | 9/9 | Mortality | Cases, 44%; controls, 33% | P > 0.05 | 9 |
| LOS | Cases, 37 ± 25 days; controls, 15 ± 10 days | P = 0.04 | ||||||
| Case-control | Tertiary care | Peritonitis (CAPDb) | E. coli | 11/77 | Mortality | Cases, 27.3%; controls, 3.9% | P = 0.02 | 83 |
| Retrospective cohort | Tertiary care | BSI | Enterobacteriaceae | 99/99a | LOS | Cases, 1.56 greater duration | P = 0.001 | 68 |
| Increased cost | Cases, 1.57 times higher cost | P = 0.003 | ||||||
| Retrospective cohort | Tertiary care | Non-urinary tract | E. coli and Klebsiella spp. | 21/21a | Mortality | Cases, 8%; controls, 14% | P = 0.182 | 44 |
| LOS | Cases, 21 days; controls, 11 days | P = 0.006 | ||||||
| Increased cost | Attributable cost, $16,450 | $965-31,937 | ||||||
| Retrospective cohort | Tertiary care | BSI | K. pneumoniae | 46/82a | Mortality | ORc for death in cases, 2.66 | 1.07-6.59 | 76 |
| LOS | Cases, 22 days; controls, 16 days | P = 0.03 | ||||||
| Prospective cohort | Tertiary care | BSI | E. coli | 46/308a | Mortality | OR for death in cases, 3.57 | 1.48-8.60 | 47 |
| Studies showing no impact of resistance | ||||||||
| Case-control | Tertiary care | Nosocomial | Enterobacteriaceae | 23/174 | Mortality | Cases, 26%; controls, 16% | P = 0.14 | 18 |
| Case-control | Tertiary care | Nosocomial | K. pneumoniae | 60/60a,d | Mortality | Cases, 30%; controls, 28.3% | P = 0.0841 | 33 |
| Case-control | Tertiary care | Nosocomial | Enterobacteriaceae | 31/39 | Mortality | Cases, 3.0%; controls, 2.4% | P > 0.05 | 13 |
| Case-control | Tertiary care | BSI | E. coli and | 35/105a | LOS | Cases, 8.2 additional days | P = 0.182 | 84 |
| Klebsiella spp. | ||||||||
| Retrospective cohort | Tertiary care | Nosocomial | K. pneumoniae | 68/75a | Mortality | RRe, 0.94 | 0.45-1.97 | 28 |
| Prospective cohort | Multicenter | BSI or pneumonia | Enterobacteriaceae | 135/40 | Mortality | Cases, 5.2%; controls, 12.5% | P = 0.15 | 4 |
a
Studies with either matched controls or multivariate analysis, in order to minimize confounding.
b
CAPD, continuous ambulatory peritoneal dialysis.
c
OR, odds ratio.
d
Matched controls.
e
RR, risk ratio.