Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Pusan, South Korea.
J Hosp Infect. 2024 Feb;144:85-93. doi: 10.1016/j.jhin.2023.11.013. Epub 2023 Dec 10.
Despite the significant impact of multi-drug-resistant bacteraemia, especially extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenem-resistant Enterobacterales (CRE), the burden of disease has not been investigated thoroughly.
To evaluate the clinical outcomes and socio-economic burden of ESBL-E and CRE bacteraemia nationwide in the Republic of Korea.
A search was undertaken for all cases of ESBL-E and CRE bacteraemia and matched controls in 10 hospitals in the Republic of Korea over 6 months. Patients with ESBL-E or CRE bacteraemia were classified as the R group, and matched controls with antibiotic-susceptible bacteraemia and without infection were classified as the S and N groups, respectively. Patients' clinical data were collected, and the economic burden was estimated based on medical expenses, loss of productivity and total costs.
In total, 795 patients were identified, including 265 patients with ESBL-E or CRE bacteraemia and their matched controls. The mean total length of stay for patients with ESBL-E and CRE in the R group was 1.53 and 1.90 times that of patients in the S group, respectively. The 90-day mortality rates for ESBL-E in the R and S groups were 12.1% and 5.6%, respectively, and the corresponding figures for CRE were 28.6% and 12.0%. There were significant differences in the total costs between the R, S and N groups for both ESBL-E and CRE (ESBL-E: $11,151 vs $8712 vs $6063, P=0.004; CRE: $40,464 vs $8748 vs $7279, P=0.024).
The clinical and economic burden imposed by ESBL-E or CRE bacteraemia was extremely high. These findings suggest that efforts to control resistant bacteraemia are necessary to reduce this burden.
尽管多药耐药菌血症，尤其是产超广谱β-内酰胺酶肠杆菌科（ESBL-E）和耐碳青霉烯肠杆菌科（CRE）的影响巨大，但疾病负担尚未得到充分调查。
评估韩国全国范围内 ESBL-E 和 CRE 菌血症的临床结局和社会经济负担。
在韩国的 10 家医院进行了为期 6 个月的所有 ESBL-E 和 CRE 菌血症病例和匹配对照的检索。将 ESBL-E 或 CRE 菌血症患者分为 R 组，将抗生素敏感性菌血症且无感染的匹配对照患者分为 S 组和 N 组。收集患者的临床数据，并根据医疗费用、生产力损失和总成本来估计经济负担。
共确定了 795 例患者，包括 265 例 ESBL-E 或 CRE 菌血症患者及其匹配对照。R 组中 ESBL-E 和 CRE 患者的平均总住院时间分别为 S 组的 1.53 倍和 1.90 倍。R 组和 S 组中 ESBL-E 的 90 天死亡率分别为 12.1%和 5.6%，CRE 的死亡率分别为 28.6%和 12.0%。对于 ESBL-E 和 CRE，R、S 和 N 组之间的总费用均存在显著差异（ESBL-E：$11151 比 $8712 比 $6063，P=0.004；CRE：$40464 比 $8748 比 $7279，P=0.024）。
ESBL-E 或 CRE 菌血症带来的临床和经济负担极其沉重。这些发现表明，需要努力控制耐药菌血症以减轻这种负担。
