Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji
Issued Date
2022-09-01
Resource Type
ISSN
22137165
eISSN
22137173
Scopus ID
2-s2.0-85135104858
Pubmed ID
35738385
Journal Title
Journal of Global Antimicrobial Resistance
Volume
30
Start Page
286
End Page
293
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Global Antimicrobial Resistance Vol.30 (2022) , 286-293
Suggested Citation
Loftus M.J., Young-Sharma T.E.M.W., Lee S.J., Wati S., Badoordeen G.Z., Blakeway L.V., Byers S.M.H., Cheng A.C., Cooper B.S., Cottingham H., Jenney A.W.J., Hawkey J., Macesic N., Naidu R., Prasad A., Prasad V., Tudravu L., Vakatawa T., van Gorp E., Wisniewski J.A., Rafai E., Peleg A.Y., Stewardson A.J. 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 Vol.30 (2022) , 286-293. 293. doi:10.1016/j.jgar.2022.06.016 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/84923
Title
Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji
Other Contributor(s)
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.