Excess burden of antibiotic-resistant bloodstream infections: evidence from a multicentre retrospective cohort study in Chile, 2018–2022

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dc.article.number100943
dc.article.number100943
dc.catalogadorgjm
dc.contributor.authorAllel, Kasim
dc.contributor.authorPeters, Anne
dc.contributor.authorHaghparast-Bidgoli, Hassan
dc.contributor.authorSpencer-Sandino, Maria
dc.contributor.authorConejeros Pavez, José Daniel Hernán
dc.contributor.authorGarcía Cañete, Patricia
dc.contributor.authorPouwels, Koen B.
dc.contributor.authorYakob, Laith
dc.contributor.authorMunita, José M.
dc.contributor.authorUndurraga Fourcade, Eduardo Andrés
dc.date.accessioned2025-03-06T15:14:33Z
dc.date.available2025-03-06T15:14:33Z
dc.date.issued2024
dc.description.abstractBackground: Antibiotic-resistant bloodstream infections (ARB BSI) cause an enormous disease and economic burden. We assessed the impact of ARB BSI caused by high- and critical-priority pathogens in hospitalised Chilean patients compared to BSI caused by susceptible bacteria. Methods: We conducted a retrospective cohort study from 2018 to 2022 in three Chilean hospitals and measured the association of ARB BSI with in-hospital mortality, length of hospitalisation (LOS), and intensive care unit (ICU) admission. We focused on BSI caused by Acinetobacter baumannii, Enterobacterales, Staphylococcus aureus, Enterococcus species, and Pseudomonas aeruginosa. We addressed confounding using propensity scores, inverse probability weighting, and multivariate regressions. We stratified by community- and hospital-acquired BSI and assessed total hospital and productivity costs. Findings: We studied 1218 adult patients experiencing 1349 BSI episodes, with 47.3% attributed to ARB. Predominant pathogens were Staphylococcus aureus (33% Methicillin-resistant ‘MRSA’), Enterobacterales (50% Carbapenem-resistant ‘CRE’), and Pseudomonas aeruginosa (65% Carbapenem-resistant ‘CRPA’). Approximately 80% of BSI were hospital-acquired. ARB was associated with extended LOS (incidence risk ratio IRR = 1.14, 95% CI = 1.05–1.24), increased ICU admissions (odds ratio OR = 1.25; 1.07–1.46), and higher mortality (OR = 1.42, 1.20–1.68) following index blood culture across all BSI episodes. In-hospital mortality risk, adjusted for time-varying and fixed confounders, was 1.35-fold higher (1.16–1.58) for ARB patients, with higher hazard ratios for hospital-acquired MRSA and CRE at 1.37 and 1.48, respectively. Using a societal perspective and a 5% discount rate, we estimated excess costs for ARB at $12,600 per patient, with an estimated annual excess burden of 2270 disability-adjusted life years (DALYs) and $9.6 (5.0–16.4) million. Interpretation: It is urgent to develop and implement interventions to reduce the burden of ARB BSIs, particularly from MRSA and CRE. Funding: Agencia Nacional de Investigación y Desarrollo ANID, Chile.
dc.description.funderNational Institute for Health Research
dc.description.funderANID
dc.description.funderRoyal Society of Tropical Medicine and Hygiene
dc.description.funderSOCHINF
dc.description.funderMedical Research Foundation
dc.description.funderCIFAR
dc.description.funderMSD
dc.description.funderPfizer
dc.description.funderHPRU
dc.description.funderBeca de Doctorado en el Extranjero
dc.description.funderFondo Nacional de Desarrollo Científico y Tecnológico FONDECYT
dc.description.funderHSA
dc.description.funderWellcome Trust
dc.description.funderWaltham Foundation
dc.description.funderEU
dc.description.funderFONDAP
dc.format.extent15 páginas
dc.fuente.origenSCOPUS
dc.identifier.doi10.1016/j.lana.2024.100943
dc.identifier.issn2667-193X
dc.identifier.scopusidSCOPUS_ID:85208577536
dc.identifier.urihttps://doi.org/10.1016/j.lana.2024.100943
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/102391
dc.information.autorucInstituto de Sociología; Conejeros Pavez, José Daniel Hernán; S/I; 222324
dc.information.autorucEscuela de Medicina; García Cañete, Patricia; 0000-0002-3817-4896; 73909
dc.information.autorucEscuela de Gobierno; Undurraga Fourcade, Eduardo Andrés; 0000-0002-4425-1253; 12868
dc.language.isoen
dc.nota.accesosin adjunto
dc.revistaThe Lancet Regional Health - Americas
dc.rightsacceso abierto
dc.rights.licenseCC BY-NC 4.0 Attribution-NonCommercial 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.subjectAntibiotic resistance
dc.subjectBloodstream infections
dc.subjectCRE
dc.subjectDisease burden
dc.subjectLatin America
dc.subjectMortality
dc.subjectMRSA
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleExcess burden of antibiotic-resistant bloodstream infections: evidence from a multicentre retrospective cohort study in Chile, 2018–2022
dc.typeartículo
dc.volumen40
sipa.codpersvinculados222324
sipa.codpersvinculados73909
sipa.codpersvinculados12868
sipa.trazabilidadSCOPUS;2024-11-17
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