Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji
ABSTRACT: Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin resistance (3GC-R) on mortality and exc...
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| Language: | English |
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Elsevier
2022-09-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716522001515 |
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| author | Michael J. Loftus Tracey E.M.W. Young-Sharma Sue J. Lee Shitanjni Wati Gnei Z. Badoordeen Luke V. Blakeway Sally M.H. Byers Allen C. Cheng Ben S. Cooper Hugh Cottingham Adam W.J. Jenney Jane Hawkey Nenad Macesic Ravi Naidu Amitesh Prasad Vinita Prasad Litia Tudravu Timoci Vakatawa Elke van Gorp Jessica A. Wisniewski Eric Rafai Anton Y. Peleg Andrew J. Stewardson |
| author_facet | Michael J. Loftus Tracey E.M.W. Young-Sharma Sue J. Lee Shitanjni Wati Gnei Z. Badoordeen Luke V. Blakeway Sally M.H. Byers Allen C. Cheng Ben S. Cooper Hugh Cottingham Adam W.J. Jenney Jane Hawkey Nenad Macesic Ravi Naidu Amitesh Prasad Vinita Prasad Litia Tudravu Timoci Vakatawa Elke van Gorp Jessica A. Wisniewski Eric Rafai Anton Y. Peleg Andrew J. Stewardson |
| author_sort | Michael J. Loftus |
| collection | DOAJ |
| description | ABSTRACT: Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji. Methods: We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and we used multistate modelling to estimate the excess length of hospital stay. Results: From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs; 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio [aHR] 1.13, 95% confidence interval [CI] 0.51–2.53) or being discharged alive (aHR 0.99, 95% CI 0.65–1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36–1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31–9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5–2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission. Conclusion: Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality. |
| first_indexed | 2024-12-10T11:08:58Z |
| format | Article |
| id | doaj.art-9e5c3937b73c473fb03a980ad3b100e1 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-12-10T11:08:58Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-9e5c3937b73c473fb03a980ad3b100e12022-12-22T01:51:29ZengElsevierJournal of Global Antimicrobial Resistance2213-71652022-09-0130286293Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, FijiMichael J. Loftus0Tracey E.M.W. Young-Sharma1Sue J. Lee2Shitanjni Wati3Gnei Z. Badoordeen4Luke V. Blakeway5Sally M.H. Byers6Allen C. Cheng7Ben S. Cooper8Hugh Cottingham9Adam W.J. Jenney10Jane Hawkey11Nenad Macesic12Ravi Naidu13Amitesh Prasad14Vinita Prasad15Litia Tudravu16Timoci Vakatawa17Elke van Gorp18Jessica A. Wisniewski19Eric Rafai20Anton Y. Peleg21Andrew J. Stewardson22Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaColonial War Memorial Hospital, Suva, FijiDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaColonial War Memorial Hospital, Suva, FijiDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, AustraliaCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, ThailandDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Fiji National University, Suva, FijiDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Centre to Impact AMR, Monash University, Melbourne, AustraliaColonial War Memorial Hospital, Suva, FijiColonial War Memorial Hospital, Suva, FijiColonial War Memorial Hospital, Suva, FijiColonial War Memorial Hospital, Suva, FijiColonial War Memorial Hospital, Suva, FijiDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, AustraliaFiji Ministry of Health and Medical Services, Suva, FijiDepartment of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia; Alternative corresponding author. Mailing address: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne VIC 3004, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Corresponding author. Mailing address: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne VIC 3004, Australia.ABSTRACT: Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji. Methods: We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and we used multistate modelling to estimate the excess length of hospital stay. Results: From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs; 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio [aHR] 1.13, 95% confidence interval [CI] 0.51–2.53) or being discharged alive (aHR 0.99, 95% CI 0.65–1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36–1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31–9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5–2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission. Conclusion: Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.http://www.sciencedirect.com/science/article/pii/S2213716522001515Bloodstream infectionEnterobacteralesMortalityAntimicrobial resistanceFiji |
| spellingShingle | Michael J. Loftus Tracey E.M.W. Young-Sharma Sue J. Lee Shitanjni Wati Gnei Z. Badoordeen Luke V. Blakeway Sally M.H. Byers Allen C. Cheng Ben S. Cooper Hugh Cottingham Adam W.J. Jenney Jane Hawkey Nenad Macesic Ravi Naidu Amitesh Prasad Vinita Prasad Litia Tudravu Timoci Vakatawa Elke van Gorp Jessica A. Wisniewski Eric Rafai Anton Y. Peleg Andrew J. Stewardson Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji Journal of Global Antimicrobial Resistance Bloodstream infection Enterobacterales Mortality Antimicrobial resistance Fiji |
| title | Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji |
| title_full | Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji |
| title_fullStr | Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji |
| title_full_unstemmed | Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji |
| title_short | Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji |
| title_sort | attributable mortality and excess length of stay associated with third generation cephalosporin resistant enterobacterales bloodstream infections a prospective cohort study in suva fiji |
| topic | Bloodstream infection Enterobacterales Mortality Antimicrobial resistance Fiji |
| url | http://www.sciencedirect.com/science/article/pii/S2213716522001515 |
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