Division of Pharmacy Practice, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Infect Control Hosp Epidemiol. 2022 Oct;43(10):1349-1359. doi: 10.1017/ice.2021.446. Epub 2021 Nov 2.
To assess the impact of carbapenem resistance and delayed appropriate antibiotic therapy (DAAT) on clinical and economic outcomes among patients with Enterobacterales infection.
This retrospective cohort study was conducted in a tertiary-care medical center in Thailand. Hospitalized patients with Enterobacterales infection were included. Infections were classified as carbapenem-resistant Enterobacterales (CRE) or carbapenem-susceptible Enterobacterales (CSE). Multivariate Cox proportional hazard modeling was used to examine the association between CRE with DAAT and 30-day mortality. Generalized linear models were used to examine length of stay (LOS) and in-hospital costs.
In total, 4,509 patients with Enterobacterales infection (age, mean 65.2 ±18.7 years; 43.3% male) were included; 627 patients (13.9%) had CRE infection. Among these CRE patients, 88.2% received DAAT. CRE was associated with additional medication costs of $177 (95% confidence interval [CI], 114–239; < .001) and additional in-hospital costs of $725 (95% CI, 448–1,002; < .001). Patients with CRE infections had significantly longer LOS and higher mortality rates than patients with CSE infections: attributable LOS, 7.3 days (95% CI, 5.4–9.1; < .001) and adjusted hazard ratios (aHR), 1.55 (95% CI, 1.26–1.89; < .001). CRE with DAAT were associated with significantly longer LOS, higher mortality rates, and in-hospital costs.
CRE and DAAT are associated with worse clinical outcomes and higher in-hospital costs among hospitalized patients in a tertiary-care hospital in Thailand.
评估耐碳青霉烯肠杆菌科（CRE）和延迟恰当抗生素治疗（DAAT）对肠杆菌科感染患者临床和经济结局的影响。
这是一项在泰国一家三级保健医疗中心进行的回顾性队列研究。纳入了肠杆菌科感染住院患者。将感染分为耐碳青霉烯肠杆菌科（CRE）或碳青霉烯敏感肠杆菌科（CSE）。采用多变量 Cox 比例风险模型来检验 CRE 与 DAAT 和 30 天死亡率之间的关系。采用广义线性模型来检验住院时间（LOS）和住院费用。
共纳入 4509 例肠杆菌科感染患者（年龄，平均 65.2±18.7 岁；43.3%为男性）；627 例（13.9%）患者感染 CRE。在这些 CRE 患者中，88.2%接受了 DAAT。与 CSE 感染相比，CRE 感染患者的额外药物费用为 177 美元（95%置信区间[CI]，114239；<0.001），额外住院费用为 725 美元（95%CI，4481002；<0.001）。与 CSE 感染相比，CRE 感染患者的 LOS 更长，死亡率更高：归因 LOS 为 7.3 天（95%CI，5.49.1；<0.001），校正后风险比（aHR）为 1.55（95%CI，1.261.89；<0.001）。DAAT 联合 CRE 感染与 LOS 延长、死亡率升高和住院费用增加显著相关。
在泰国的一家三级保健医院中，CRE 和 DAAT 与住院患者的临床结局恶化和住院费用增加有关。
