Socioeconomic Burden of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacteriaceae

Figures & data

Table 1 Demographic and Clinical Characteristics of the Patients with Bacteremia Caused by CRE or CSE

		CSE	CRE	P-value
		(n=727)	(n=152)
Species, n (%)
K. pneumoniae		293 (40.3)	135 (88.8)
E. coli		434 (59.7)	17 (11.2)
Demographic
Gender	Male, n (%)	434 (59.7)	115 (75.7)	<0.001
Age	Years, (median, IQR)	60 (49–70)	59.5 (49–67)	0.582
Transplantation while in hospital, n (%)		29 (4.0)	26 (17.1)	<0.001
ICU stay while in hospital, n (%)		135 (18.6)	98 (64.5)	<0.001
Nosocomial infection, n (%)		521 (71.7)	152 (100)	<0.001
Severity of illness at time of BSI
APACHEII score (median, IQR)		9 (6–12)	12 (8–17)	<0.001
Pitt score (median, IQR)		1 (0–2)	2 (1–4)	<0.001
Charlson comorbidity score (median, IQR)		2 (0–2)	2 (1–3)	<0.001
Total hospital stay, days (median, IQR)		20 (11–36)	35 (17.25–67.25)	<0.001
Hospital stay after BSI, days (median, IQR)		13 (7–22)	13 (4–28.75)	0.979
Mortality, n (%)
Total		133 (18.3)	87 (57.2)	<0.001
28 days		113 (15.5)	80 (52.6)	<0.001
14 days		80 (11.0)	60 (39.5)	<0.001
7 days		61 (8.4)	46 (30.3)	<0.001

Note: Data are expressed as numbers (%) unless otherwise stated.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; BSI, bloodstream infection; CCI, Charlson comorbidity index; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; KP, Klebsiella pneumoniae; E. coli, Escherichia coli; ICU, intensive care unit; IQR, interquartile range.

Table 2 Features of the Patients with Bacteremia Caused by CRE or CSE After PSM for Potential Confounding Variables

		CSE	CRE	P-value
		(n=112)	(n=112)
Species, n (%)
K. pneumoniae		69 (61.6)	96 (85.7)
E. coli		43 (38.4)	16 (14.3)
Demographic
Gender	Male, n (%)	84 (75)	84 (75)	1.000
Age	Years, (median, IQR)	62 (47.8–70)	58.5 (48.8–67)	0.979
Transplantation while in hospital, n (%)		17 (15.2)	17 (15.2)	1.000
ICU stay while in hospital, n (%)		65 (58.0)	66 (58.9)	0.892
Nosocomial infection, n (%)		111 (99.2)	112 (100)	0.317
Severity of illness at time of BSI
APACHEII score (median, IQR)		11 (8–15)	12 (8.8–30.3)	0.450
Pitt score (median, IQR)		2 (0–3.3)	2 (0.8–4)	0.517
Charlson comorbidity score (median, IQR)		2 (1–3)	2 (1–3)	0.581
Total hospital stay, days (median, IQR)		29 (17–43.5)	35 (18–66)	0.089
Hospital stay after BSI, days (median, IQR)		16.5 (8–28)	12.5 (4.8–30.3)	0.493
Mortality, n (%)
Total		43 (38.4)	57 (50.1)	0.060
28 days		36 (32.1)	51 (45.5)	0.040
14 days		25 (22.3)	42 (47.5)	0.013
7 days		18 (16.1)	31 (27.7)	0.036

Note: Data are expressed as numbers (%) unless otherwise stated.

Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; KP, Klebsiella pneumoniae; E. coli, Escherichia coli; IQR, interquartile range.

Table 3 Socioeconomic Burden of the Patients with BSI Caused by CRE or CSE After PSM for Potential Confounding Variables

		CSE	CRE	P-value
		(n=112)	(n=112)
Total direct medical expenses while in hospital, $US (median, IQR)		16,864.0 (8353.7–36,556.2)	24,940.1 (11,117.1–60,442.7)	0.017
Hospitalizing		211.8 (115.6–524.5)	266.5 (133.4–705.6)	0.184
Nursing		156.6 (54.0–308.6)	209.5 (90.7–445.7)	0.050
Medicine		8102.9 (3298.7–17,891.2)	13,498.3 (6702.7–31,056.7)	0.001
Traditional Chinese medicines		2.0 (0.0–38.5)	0.0 (0.0–32.4)	0.678
Laboratory and imaging examinations		1995.3 (940.8–4352.2)	3010.4 (1157.3–6427.6)	0.049
Oxygen		329.0 (121.4–697.4)	555.4 (216.4–1132.1)	0.005
Blood transfusion		121.8 (0.0–613.9)	337.2 (32.8–1606.7)	0.003
Consultation		47.0 (87.0–19.8)	57.9 (21.4–109.6)	0.197
Surgery		77.8 (0.0–710.9)	77.8 (0.0–854.5)	0.669
Others		499.5 (268.5–1119.5)	671.3 (336.2–1430.2)	0.127
Direct medical expenses after BSI onset, $US (median, IQR)		8498.0 (3136.8–20,150.2)	10,403.4 (4967.1–24,995.0)	0.178
Hospitalizing		135.9 (56.9–289.4)	112.5 (39.2–288.4)	0.586
Nursing		103.7 (21.2–244.9)	87.8 (20.7–205.5)	0.836
Medicine		4342.8 (1794.3–10,396.9)	5892.6 (2668.8–15,299.3)	0.107
Traditional Chinese medicines		0.0 (0.0–14.2)	0.0 (0.0–7.0)	0.224
Laboratory and imaging examinations tests		1109.6 (376.5–2690.5)	1253.1 (441.6–2936.6)	0.376
Oxygen		178.9 (41.6–519.5)	253.1 (64.1–608.9)	0.145
Blood transfusion		0.0 (0.0–362.9)	162.8 (0.0–607.7)	0.037
Consultation		26.5 (10.3–57.9)	21.7 (6.8–53.7)	0.437
Surgery		0.0 (0.0–99.7)	0.0 (0.0–120.2)	0.782
Others		269.5 (68.1–631.7)	226.4 (73.9–589.3)	0.662
Total antibiotic costs while in hospital, $US (median, IQR)		3693.0 (1194.4–7179.9)	5904.9 (2705.5–11,726.1)	0.001
Antibiotic costs after infection, $US (median, IQR)		1836.3 (727.4–4952.4)	2647.5 (969.1–6390.7)	0.190
Total indirect loss $US (median, IQR)		1139.9 (41.8–14,893.5)	3848.5 (69.4–90,752.1)	0.304
Median DALY, yr		6.7	7.9	0.190

Note: Data are expressed as $(US dollars) unless otherwise stated.

Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae; KP, Klebsiella pneumoniae; DALY, disability-adjusted life year; IQR, interquartile range; $, US dollars.

Table 4 Indirect Economic Loss to Patients Caused by Enterobacteriaceae Bacteremia in Different Age Groups

	CSE			CRE			Enterobacteriaceae
	(n=112)			(n=112)			(n=224)
Age Group, Year	Number, n	Average DALY, Year	Average Indirect Economic Loss, $	Number, n	Average DALY, Year	Average Indirect Economic Loss, $	Number, n	Average DALY, Year	Average Indirect Economic Loss, $
16~29	7	15.7	88,611.3	4	16.6	97,214.8	11	16.0	91,739.8
30~44	15	12.6	70,570.1	13	9.8	58,374.2	28	11.3	64,907.7
45~59	30	8.2	50,263.9	44	10.9	67,912.3	74	9.8	60,757.5
60~74	45	3.9	2969.9	36	4.8	3747.1	81	4.3	3315.3
>74	15	1.8	1327.1	15	2.6	1937.9	30	2.2	1632.5
Total	112	6.7	29,824.1	112	7.9	38,391.3	224	7.3	34,107.7

Abbreviations: CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenems susceptible Enterobacteriaceae; $, US dollars.

Table 5 Yearly Socioeconomic Burden per Patient in Patients with Bacteremia from 2013 to 2015

Year		CSE			CRE			Enterobacteriaceae
	GDP	Direct Economic Burden	Indirect Economic Burden	Social Economic Burden	Direct Economic Burden	Indirect Economic Burden	Social Economic Burden	Direct Economic Burden	Indirect Economic Burden	Social Economic Burden
2013	7023.2	25,144.9	29,663.2	54,808.1	42,624.6	21,279.3	63,903.9	32,948.4	25,920.4	58,868.8
2014	7584.1	34,747.7	29,352.5	64,100.2	60,490.7	35,038.6	95,529.3	46,032.3	31,845.0	77,877.4
2015	8076.7	31,082.3	31,017.9	62,100.2	45,219.5	48,120.2	93,339.7	39,267.0	40,919.2	80,186.2

Note: All results reported as US $.

Abbreviations: GDP, gross domestic product; CRE, carbapenem-resistant Enterobacteriaceae; CSE, carbapenem-susceptible Enterobacteriaceae.