Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital.
BACKGROUND
The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital.


METHODS
We conducted a retrospective, matched case-control-control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection.


RESULTS
Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26-12.42), tracheostomy (OR:2.24; 95%CI: 1.14-4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31-28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52-95.4), urinary system disease (OR: 16.69; 95%CI: 3.01-89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46-5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89-26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01).


CONCLUSION
Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.
['Meng|Xiujuan|X|', 'Liu|Sidi|S|', 'Duan|Juping|J|', 'Huang|Xun|X|', 'Zhou|Pengcheng|P|', 'Xiong|Xinrui|X|', 'Gong|Ruie|R|', 'Zhang|Ying|Y|', 'Liu|Yao|Y|', 'Fu|Chenchao|C|', 'Li|Chunhui|C|', 'Wu|Anhua|A|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D000890:Anti-Infective Agents D015780:Carbapenems D016022:Case-Control Studies D002405:Catheterization, Central Venous D002648:Child D002675:Child, Preschool D002681:China D003428:Cross Infection D016527:Drug Costs D024881:Drug Resistance, Bacterial D004927:Escherichia coli Infections D005260:Female D017048:Health Care Costs D006454:Hemoglobins D006784:Hospitals, Teaching D006801:Humans D006943:Hyperglycemia D015994:Incidence D007223:Infant D007231:Infant, Newborn D007902:Length of Stay D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D012189:Retrospective Studies D012307:Risk Factors D062606:Tertiary Care Centers D014139:Tracheostomy D014570:Urologic Diseases D055815:Young Adult
Risk factors CREC CSEC Healthcare-associated infection