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Health and Economic Outcomes of the Emergence of Third-Generation Cephalosporin Resistance in Enterobacter Species
Sara E. Cosgrove, MD, MS;
Keith S. Kaye, MD, MPH;
George M. Eliopoulous, MD;
Yehuda Carmeli, MD, MPH
Arch Intern Med. 2002;162:185-190.
Background This study evaluated the clinical and economic impact of the emergence
of third-generation cephalosporin–resistant Enterobacter species.
Methods Mortality, length of hospitalization, and hospital charges were examined
in a cohort that was selected from a group of 477 patients with initial cultures
that yielded a third-generation cephalosporin–susceptible Enterobacter species. Case patients (n = 46) had subsequent cultures
yielding a third-generation cephalosporin–resistant Enterobacter species. Control patients (n = 113) who did not develop
resistance were matched to cases on site of Enterobacter infection and length of hospitalization prior to isolation of the
initial susceptible organism. Multivariable analyses were used to adjust for
confounding.
Results Twenty-six percent of cases died vs 13% of controls (P = .06). The median total hospital stay for cases was 29.5 days (interquartile
range [IQR], 20-60) and 19 days for controls (IQR, 13-27; P<.001). The median hospital charge for cases was $79 323 (IQR,
$34 546-$161 384) and for controls was $40 406 (IQR, $18 470-$79 005; P<.001). After adjusting for comorbidities, severity
of illness, intensive care unit admission, surgery, transfer from another
hospital, sex, and age, emergence of resistance was associated with increased
mortality (relative risk, 5.02; P = .01), hospital
stay (1.5-fold, P<.001), and hospital charges
(1.5-fold, P<.001). Emergence of resistance had
a median attributable hospital stay of 9 days and an average attributable
hospital charge of $29 379.
Conclusions Emergence of antibiotic resistance in Enterobacter species results in increased mortality, hospital stay, and hospital
charges. Minimizing resistance in Enterobacter species
should be a priority.
From the Division of Infectious Diseases, Beth Israel Deaconess Medical
Center, and Harvard Medical School, Boston, Mass (Drs Cosgrove, Eliopoulous,
and Carmeli); Division of Infectious Diseases, Department of Medicine, Duke
University Medical Center, Durham, NC (Dr Kaye); and Division of Infectious
Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Carmeli).
Dr Cosgrove is now with the Department of Medicine, The John Hopkins Hospital,
Baltimore, Md. Dr Eliopoulous has relationships with the following corporations:
Aventis (speaker, contract, consultant), Bayer (consultant, speaker), Bristol
Myers Squibb (consultant), Ortho McNeil Pharmaceuticals (speaker, consultant,
contract), SmithKline Beecham (consultant), and Wyeth-Ayerst (consultant,
contract, speaker). Dr Carmeli has received grants, honoraria, travel support,
and other forms of financial support from the following companies: Bayer Corp,
Biomedicum LTD, Bristol Mayer Squib, Eli Lilly, Merck & Co Inc, Neopharm
LTD, Pharmacia Corp, SmithKline Beecham, Roche, and XTL Pharamceuticals LTD.
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