Costs and length of stay associated with extended-spectrum β-lactamase production in cases of Escherichia coli bloodstream infection.

Abstract

The prevalence of infections with extended-spectrum β-lactamase (ESBL)-producing bacteria is increasing worldwide. The economic burden of this development has not yet been sufficiently studied. Therefore, this study on hospital costs and length of stay (LoS) associated with cases of bloodstream infection (BSI) due to ESBL-producing Escherichia coli was performed. A matched case-control study of patients with E. coli BSI between 2008 and 2010 in Charité University Hospital (Berlin, Germany) was performed. Cases were patients with ESBL-producing E. coli BSI and controls were patients with ESBL-negative E. coli BSI. Cases and controls were matched in a 1:1 ratio by age ±5 years, sex, underlying co-morbidities, LoS before BSI onset, and discharge year. In total, 1098 consecutive patients with E. coli BSI were identified, comprising 115 (10.5%) ESBL-positive and 983 (89.5%) ESBL-negative. Of the 115 ESBL-positive infections 67 (58.3%) were hospital-acquired in contrast to 382/983 (38.9%) of the ESBL-negative infections (P<0.001). After matching for confounders, there were no significant differences in costs, LoS or mortality between ESBL-positive and ESBL-negative E. coli BSIs. In conclusion, patients with BSI due to ESBL-producing E. coli were neither more costly nor stayed longer in the hospital than patients with BSI due to ESBL-negative E. coli.