Next Article in Journal
Public Awareness and Practices towards Self-Medication with Antibiotics among the Malaysian Population. A Development of Questionnaire and Pilot-Testing
Next Article in Special Issue
Impact of Reappraisal of Fluoroquinolone Minimum Inhibitory Concentration Susceptibility Breakpoints in Gram-Negative Bloodstream Isolates
Previous Article in Journal
Antibiotics and Antimicrobials for Treatment of the Oral Microbiota: Myths and Facts in Research and Clinical Practice
Previous Article in Special Issue
Definitive Cefazolin Treatment for Community-Onset Enterobacteriaceae Bacteremia Based on the Contemporary CLSI Breakpoint: Clinical Experience of a Medical Center in Southern Taiwan
Article

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

1
Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA 52246, USA
2
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
*
Author to whom correspondence should be addressed.
Received: 31 January 2020 / Revised: 17 February 2020 / Accepted: 19 February 2020 / Published: 23 February 2020
(This article belongs to the Special Issue Gram-Negative Bloodstream Infections)
Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E. coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions. View Full-Text
Keywords: multistate model; length of stay; hospital-onset bacteremia; healthcare-associated infection; antimicrobial resistance multistate model; length of stay; hospital-onset bacteremia; healthcare-associated infection; antimicrobial resistance
Show Figures

Figure 1

MDPI and ACS Style

Suzuki, H.; Perencevich, E.N.; Nair, R.; Livorsi, D.J.; Goto, M. Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis. Antibiotics 2020, 9, 96. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9020096

AMA Style

Suzuki H, Perencevich EN, Nair R, Livorsi DJ, Goto M. Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis. Antibiotics. 2020; 9(2):96. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9020096

Chicago/Turabian Style

Suzuki, Hiroyuki, Eli N. Perencevich, Rajeshwari Nair, Daniel J. Livorsi, and Michihiko Goto. 2020. "Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis" Antibiotics 9, no. 2: 96. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9020096

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop