1Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China.
2Global Health-Health Systems and Policy (HSP): Medicines, focusing antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Antimicrob Resist Infect Control. 2019 Aug 13;8:137. doi: 10.1186/s13756-019-0590-7. eCollection 2019.
Antibiotic resistance (ABR) is one of the biggest threats to global health. Infections by ESKAPE (, , , , , and ) organisms are the leading cause of healthcare-acquired infections worldwide. ABR in ESKAPE organisms is usually associated with significant higher morbidity, mortality, as well as economic burden. Directing attention towards the ESKAPE organisms can help us to better combat the wide challenge of ABR, especially multi-drug resistance (MDR).
This study aims to systematically review and evaluate the evidence of the economic consequences of ABR or MDR ESKAPE organisms compared with susceptible cases or control patients without infection/colonization in order to determine the impact of ABR on economic burden.
Both English-language databases and Chinese-language databases up to 16 January, 2019 were searched to identify relevant studies assessing the economic burden of ABR. Studies reported hospital costs (charges) or antibiotic cost during the entire hospitalization and during the period before/after culture among patients with ABR or MDR ESKAPE organisms were included. The costs were converted into 2015 United States Dollars. Disagreements were resolved by a third reviewer.
Of 13,693 studies identified, 83 eligible studies were included in our review. The most studied organism was , followed by , , , or/and , , and . There were 71 studies on total hospital cost or charge, 12 on antibiotic cost, 11 on hospital cost or charge after culture, 4 on ICU cost, 2 on hospital cost or charge before culture, and 2 on total direct and indirect cost. In general, ABR or MDR ESKAPE organisms are significantly associated with higher economic burden than those with susceptible organisms or those without infection or colonization. Nonetheless, there were no differences in a few studies between the two groups on total hospital cost or charge (16 studies), antibiotic cost (one study), hospital cost before culture (one study), hospital cost after culture (one study). Even, one reported that costs associated with MSSA infection were higher than the costs for similar MRSA cases.
ABR in ESKAPE organisms is not always, but usually, associated with significantly higher economic burden. The results without significant differences may lack statistical power to detect a significant association. In addition, study design which controls for severity of illness and same empirical antibiotic therapy in the two groups would be expected to bias the study towards a similar, even negative result. The review also highlights key areas where further research is needed.
抗生素耐药性（ABR）是对全球健康的最大威胁之一。ESKAPE（耐甲氧西林金黄色葡萄球菌、肠球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和屎肠球菌）生物体的感染是全球卫生保健相关感染的主要原因。ESKAPE 生物体中的 ABR 通常与更高的发病率、死亡率以及经济负担有关。关注 ESKAPE 生物体可以帮助我们更好地应对 ABR 的广泛挑战，尤其是多药耐药（MDR）。
本研究旨在系统回顾和评估与敏感病例或无感染/定植对照患者相比，ABR 或 MDR ESKAPE 生物体的经济后果证据，以确定 ABR 对经济负担的影响。
检索了截至 2019 年 1 月 16 日的英文和中文数据库，以确定评估 ABR 患者的医院成本（费用）或抗生素成本的相关研究。研究报告了 ABR 或 MDR ESKAPE 生物体患者整个住院期间和培养前后的医院成本（费用）或抗生素成本。费用转换为 2015 年的美元。分歧由第三位审稿人解决。
在确定的 13693 项研究中，有 83 项符合纳入标准的研究被纳入本综述。研究最多的生物体是耐甲氧西林金黄色葡萄球菌，其次是屎肠球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和/或肠球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和/或屎肠球菌。其中 71 项研究是关于总医院费用或费用，12 项研究是关于抗生素费用，11 项研究是关于培养后医院费用或费用，4 项研究是关于 ICU 费用，2 项研究是关于培养前医院费用或费用，2 项研究是关于总直接和间接费用。一般来说，ABR 或 MDR ESKAPE 生物体与敏感生物体或无感染或定植的生物体相比，经济负担显著增加。然而，在总医院费用或费用（16 项研究）、抗生素费用（一项研究）、培养前医院费用（一项研究）、培养后医院费用（一项研究）等方面，有几项研究在两组之间没有差异。甚至有一项研究报告称，耐甲氧西林金黄色葡萄球菌感染的相关费用高于类似耐甲氧西林金黄色葡萄球菌病例的费用。
ESKAPE 生物体中的 ABR 并不总是但通常与显著更高的经济负担相关。没有显著差异的结果可能缺乏检测显著关联的统计能力。此外，在两组中控制疾病严重程度和相同经验性抗生素治疗的研究设计预计会使研究偏向于类似的、甚至是负面的结果。该综述还突出了需要进一步研究的关键领域。
