Economic Burden of Patients with Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli

Figures & data

Table 1 Characteristics of Patients with Escherichia coli Bloodstream Infection (BSI) Stratified by Extended-Spectrum-Lactamase (ESBL) Production^a

Parameter/Category	Non-SBL (n = 247)	ESBL (n=333)	P
Male sex, n (%)	138 (55.9)	184 (55.3)	0.883
Age in years, (median, IQR)	60 (47–71)	61 (49.5–70.5)	0.967
Organ transplantation during hospitalization, n (%)	11 (4.5)	18 (5.4)	0.603
LOS in days
Total LOS in days, (median, IQR)	20 (11–31)	19 (11–36.5)	0.809
LOS after the bacteremia in days, (median, IQR)	11 (7–21)	12 (7–21)	0.38
Combined with other bacterial infections, n (%)	13 (5.3)	20 (6.0)	0.703
Admission to ICU before bacteremia, n (%)	18 (7.3)	29 (8.7)	0.535
APACHEII score, (median, IQR)	9 (6–13)	9 (6–13)	0.951
Pitt score, (median, IQR)	1 (0–2)	0 (0–2)	0.364
Comorbid illnesses (%)
Hepatobiliary disease, n (%)	73 (29.6)	93 (27.9)	0.668
Hypertension, n (%)	68 (27.5)	91 (27.3)	0.957
Malignant tumor, n (%)	49 (19.8)	68 (20.4)	0.863
Hematological diseases, n (%)	51 (20.6)	48 (14.4)	0.049
Other, n (%)	49 (19.8)	66 (19.8)	0.996
Charlson comorbidity index, (median, IQR)	2 (0–2)	2 (0–2)	0.229
Empirical antimicrobial
Cephalosporins, n (%)	16 (6.5)	26 (7.8)	0.541
BLBLI, n (%)	89 (36.0)	120 (36.0)	0.999
Carbapenems, n (%)	121 (49.0)	158 (47.4)	0.714
Tigecycline, n (%)	6 (2.4)	7 (2.1)	0.792
Aminoglycosides, n (%)	5 (2.0)	5 (1.5)	0.867
Fluoroquinolone, n (%)	43 (17.4)	43 (12.9)	0.132
Other, n (%)	5 (2.0)	9 (2.7)	0.599
Effective empirical antimicrobial therapy, n (%)	222 (89.9)	291 (87.4)	0.353
Mortality
Total mortality, n (%)	43 (17.4)	67 (20.1)	0.41
28-day mortality, n (%)	38 (15.4)	54 (16.2)	0.786
14-day mortality, n (%)	31 (12.6)	37 (11.1)	0.594
7-day mortality, n (%)	21 (8.5)	31 (9.3)	0.736

Note: ^aCategorical variables are presented as n (%) and continuous variables as median (interquartile range).

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; BSI, bloodstream infection; CCI, Charlson comorbidity index; ESBL, extended-spectrum-lactamase; BLBLI, β-lactam-β-lactamase inhibitors; E. coli, Escherichia coli.

Table 2 Costs of Patients with Escherichia coli Bloodstream Infection (BSI) Stratified by Extended-Spectrum-Lactamase (ESBL) Production^a

Costs (Median, IQR, $)	Non-ESBL (n = 247)	ESBL (n = 333)	P
Total direct economic burden	7476.84 (3470.47–16,658.55)	8048.68 (3688.81–19,358.91)	0.321
Room and board	148.50 (78.99–284.36)	148.50 (76.62–346.29)	0.769
Nursing	112.16 (44.87–215.17)	96.84 (36.73–214.22)	0.553
Medicine	3591.59 (1610.72–9019.65)	4269.80 (1600.03–10,109.30)	0.387
Antimicrobial	1430.06 (660.33–4219.78)	1592.50 (747.20–4198.98)	0.252
Cephalosporins	0 (0–5.48)	0 (0–26.84)	0.029
β-lactam-β-lactamase inhibitors	19.38 (0–372.38)	80.22 (0–516.04)	0.181
Carbapenems	406.14 (0–940.54)	525.03 (0–1100.59)	0.049
Tigecycline	0 (0–0)	0 (0–0)	0.452
Aminoglycosides	0 (0–0)	0 (0–0)	0.882
Fluoroquinolone	0 (0–538.2)	0 (0–425.25)	0.767
Anti-positive bacteria drug	0 (0–500.88)	0 (0–51.5)	0.426
Other	585.90 (187.82–2277.39)	594.17 (203.60–2168.80)	0.776
Traditional Chinese medicines	0 (0–25.75)	0 (0–25.70)	0.591
Laboratory tests	661.14 (380.25–1282.62)	705.85 (411.30–1457.03)	0.538
Ventilation	91.23 (2.49–316.63)	111.45 (27.29–318.01)	0.117
Blood transfusion	0 (0–454.98)	0 (0–280.81)	0.583
Registration fee	35.55 (16.59–66.35)	33.18 (16.51–61.61)	0.253
Surgery	0 (0–170.70)	0 (0–406.60)	0.109
Other tests	273.93 (141.71–538.07)	288.31 (134.44–584.12)	0.486
Direct economic burden after BSI	4812.31 (1900.76–10,016.93)	5106.20 (2343.98–11,680.89)	0.272
Room and board	92.42 (43.44–206.16)	96.37 (47.40–230.25)	0.398
Nursing	65.72 (21.48–132.73)	59.65 (21.95–133.79)	0.858
Medicine	2421.4 (976.78–5459.31)	2751.48 (1104.92–6336.05)	0.335
Antimicrobial	1096.41 (444.16–2547.19)	1098.90 (566.64–3014.46)	0.367
Cephalosporins	0 (0–5.48)	0 (0–11.36)	0.412
β-lactam-β-lactamase inhibitors	0(0–247.87)	0 (0–306.55)	0.322
Carbapenems	361.93 (0–812.29)	465.60 (0–985.24)	0.052
Tigecycline	0 (0–0)	0 (0–0)	0.341
Aminoglycosides	0 (0–0)	0 (0–0)	0.972
Fluoroquinolone	0 (0–23.91)	0 (0–23.91)	0.696
Anti-positive bacteria drug	0 (0–52.43)	0 (0–8.14)	0.631
Other	355.97 (77.73–1374.89)	355.97 (85.16–1332.94)	0.941
Traditional Chinese medicines	0 (0–15.47)	0 (0–15.98)	0.982
Laboratory tests	380.25 (191.63–820.22)	422.12 (215.09–877.09)	0.334
Ventilation	61.06 (0–232.43)	74.41 (13.98–243.29)	0.201
Blood transfusion	0 (0–259.08)	0 (0–206.75)	0.898
Registration fee	21.33 (9.48–40.28)	21.33 (8.53–37.91)	0.883
Surgery	0 (0–48.97)	0 (0–48.97)	0.374
Other tests	131.75 (43.60–319.74)	127.64 (57.42–344.39)	0.375
DALY
Average DALY	2.15 (1.21–3.60)	2.08 (1.38–4.07)	0.343
Total DALY	531.05 (298.87–889.2)	692.64 (459.54–1355.31)	0.343
Indirect economic burden
Average indirect economic burden	13.56 (2.56–70.79)	19.87 (2.54–85.37)	0.361
Total indirect economic burden	3349.32 (632.32–17,485.13)	6616.71 (845.82–28,428.21)	0.361

Note: ^aCategorical variables are presented as n (%) and continuous variables as median (interquartile range).

Abbreviations: ESBL, extended-spectrum-lactamase; E. coli, Escherichia coli.

Figure 1 Total DALYs (A), average DALYs (B), total indirect loss (C) and average indirect loss (D) of patients with E. coli BSI by age group and sex.