The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study
Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setti...
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| Veröffentlicht in: | PloS one 2019-09, Vol.14 (9), p.e0221944-e0221944 |
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| creator | Naylor, Nichola R Pouwels, Koen B Hope, Russell Green, Nathan Henderson, Katherine L Knight, Gwenan M Atun, Rifat Robotham, Julie V Deeny, Sarah R |
| description | Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting.
This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.
14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630).
E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting. |
| doi_str_mv | 10.1371/journal.pone.0221944 |
| format | Article |
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This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.
14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630).
E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0221944</identifier><identifier>PMID: 31504046</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Antibiotic resistance ; Antibiotics ; Antimicrobial agents ; Bacteremia ; Bacteremia - economics ; Bacteremia - epidemiology ; Bacteria ; Biology and Life Sciences ; Cephalosporins ; Cohort analysis ; Cost of Illness ; Costs ; Drug resistance ; Drug Resistance, Bacterial ; E coli ; Economics ; England ; Epidemiology ; Escherichia coli ; Escherichia coli Infections - economics ; Escherichia coli Infections - epidemiology ; Estimates ; Health care ; Health care costs ; Health hazards ; Health risks ; Health surveillance ; Hospital Costs ; Hospital patients ; Hospitals ; Hospitals - statistics & numerical data ; Humans ; Infections ; Intelligence gathering ; Internet ; Medical economics ; Medical research ; Medicine and Health Sciences ; Microbial drug resistance ; Mortality ; Patients ; Piperacillin ; Population ; Public health ; Research and Analysis Methods ; Sepsis ; Social Sciences ; Statistical analysis ; Studies ; Tazobactam</subject><ispartof>PloS one, 2019-09, Vol.14 (9), p.e0221944-e0221944</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Naylor et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Naylor et al 2019 Naylor et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c758t-d788d3acc3ac6134b9300c9d65aa3904855a618c13d5ad9c1f62c752b33728573</citedby><cites>FETCH-LOGICAL-c758t-d788d3acc3ac6134b9300c9d65aa3904855a618c13d5ad9c1f62c752b33728573</cites><orcidid>0000-0003-2745-1736 ; 0000-0003-4122-6631 ; 0000-0001-7097-8950</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736296/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736296/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31504046$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Naylor, Nichola R</creatorcontrib><creatorcontrib>Pouwels, Koen B</creatorcontrib><creatorcontrib>Hope, Russell</creatorcontrib><creatorcontrib>Green, Nathan</creatorcontrib><creatorcontrib>Henderson, Katherine L</creatorcontrib><creatorcontrib>Knight, Gwenan M</creatorcontrib><creatorcontrib>Atun, Rifat</creatorcontrib><creatorcontrib>Robotham, Julie V</creatorcontrib><creatorcontrib>Deeny, Sarah R</creatorcontrib><title>The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting.
This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.
14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630).
E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.</description><subject>Analysis</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Bacteremia</subject><subject>Bacteremia - economics</subject><subject>Bacteremia - epidemiology</subject><subject>Bacteria</subject><subject>Biology and Life Sciences</subject><subject>Cephalosporins</subject><subject>Cohort analysis</subject><subject>Cost of Illness</subject><subject>Costs</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>E coli</subject><subject>Economics</subject><subject>England</subject><subject>Epidemiology</subject><subject>Escherichia coli</subject><subject>Escherichia coli Infections - economics</subject><subject>Escherichia coli Infections - epidemiology</subject><subject>Estimates</subject><subject>Health care</subject><subject>Health care costs</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>Health surveillance</subject><subject>Hospital Costs</subject><subject>Hospital patients</subject><subject>Hospitals</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Infections</subject><subject>Intelligence gathering</subject><subject>Internet</subject><subject>Medical economics</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Microbial drug resistance</subject><subject>Mortality</subject><subject>Patients</subject><subject>Piperacillin</subject><subject>Population</subject><subject>Public health</subject><subject>Research and Analysis Methods</subject><subject>Sepsis</subject><subject>Social Sciences</subject><subject>Statistical 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health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study</title><author>Naylor, Nichola R ; Pouwels, Koen B ; Hope, Russell ; Green, Nathan ; Henderson, Katherine L ; Knight, Gwenan M ; Atun, Rifat ; Robotham, Julie V ; Deeny, Sarah R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c758t-d788d3acc3ac6134b9300c9d65aa3904855a618c13d5ad9c1f62c752b33728573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Analysis</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Bacteremia</topic><topic>Bacteremia - economics</topic><topic>Bacteremia - epidemiology</topic><topic>Bacteria</topic><topic>Biology and Life Sciences</topic><topic>Cephalosporins</topic><topic>Cohort analysis</topic><topic>Cost of 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R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-09-10</date><risdate>2019</risdate><volume>14</volume><issue>9</issue><spage>e0221944</spage><epage>e0221944</epage><pages>e0221944-e0221944</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Antibiotic resistance poses a threat to public health and healthcare systems. Escherichia coli causes more bacteraemia episodes in England than any other bacterial species. This study aimed to estimate the burden of E. coli bacteraemia and associated antibiotic resistance in the secondary care setting.
This was a retrospective cohort study, with E. coli bacteraemia as the main exposure of interest. Adult hospital in-patients, admitted to acute NHS hospitals between July 2011 and June 2012 were included. English national surveillance and administrative datasets were utilised. Cox proportional hazard, subdistribution hazard and multistate models were constructed to estimate rate of discharge, rate of in-hospital death and excess length of stay, with a unit bed day cost applied to the latter to estimate cost burden from the healthcare system perspective.
14,042 E. coli bacteraemia and 8,919,284 non-infected inpatient observations were included. E. coli bacteraemia was associated with an increased rate of in-hospital death across all models, with an adjusted subdistribution hazard ratio of 5.88 (95% CI: 5.62-6.15). Resistance was not found to be associated with in-hospital mortality once adjusting for patient and hospital covariates. However, resistance was found to be associated with an increased excess length of stay. This was especially true for third generation cephalosporin (1.58 days excess length of stay, 95% CI: 0.84-2.31) and piperacillin/tazobactam resistance (1.23 days (95% CI: 0.50-1.95)). The annual cost of E. coli bacteraemia was estimated to be £14,346,400 (2012 £), with third-generation cephalosporin resistance associated with excess costs per infection of £420 (95% CI: 220-630).
E. coli bacteraemia places a statistically significant burden on patient health and the hospital sector in England. Resistance to front-line antibiotics increases length of stay; increasing the cost burden of such infections in the secondary care setting.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31504046</pmid><doi>10.1371/journal.pone.0221944</doi><tpages>e0221944</tpages><orcidid>https://orcid.org/0000-0003-2745-1736</orcidid><orcidid>https://orcid.org/0000-0003-4122-6631</orcidid><orcidid>https://orcid.org/0000-0001-7097-8950</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-09, Vol.14 (9), p.e0221944-e0221944 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2288186585 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Analysis Antibiotic resistance Antibiotics Antimicrobial agents Bacteremia Bacteremia - economics Bacteremia - epidemiology Bacteria Biology and Life Sciences Cephalosporins Cohort analysis Cost of Illness Costs Drug resistance Drug Resistance, Bacterial E coli Economics England Epidemiology Escherichia coli Escherichia coli Infections - economics Escherichia coli Infections - epidemiology Estimates Health care Health care costs Health hazards Health risks Health surveillance Hospital Costs Hospital patients Hospitals Hospitals - statistics & numerical data Humans Infections Intelligence gathering Internet Medical economics Medical research Medicine and Health Sciences Microbial drug resistance Mortality Patients Piperacillin Population Public health Research and Analysis Methods Sepsis Social Sciences Statistical analysis Studies Tazobactam |
| title | The health and cost burden of antibiotic resistant and susceptible Escherichia coli bacteraemia in the English hospital setting: A national retrospective cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T01%3A35%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20health%20and%20cost%20burden%20of%20antibiotic%20resistant%20and%20susceptible%20Escherichia%20coli%20bacteraemia%20in%20the%20English%20hospital%20setting:%20A%20national%20retrospective%20cohort%20study&rft.jtitle=PloS%20one&rft.au=Naylor,%20Nichola%20R&rft.date=2019-09-10&rft.volume=14&rft.issue=9&rft.spage=e0221944&rft.epage=e0221944&rft.pages=e0221944-e0221944&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0221944&rft_dat=%3Cgale_plos_%3EA599005805%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2288186585&rft_id=info:pmid/31504046&rft_galeid=A599005805&rft_doaj_id=oai_doaj_org_article_626428cfb8c045138cdedc410fc2f9c3&rfr_iscdi=true |