Study on the health and economic burden of bacterial drug resistance in a tertiary care hospital——Escherichia coli producing extended-spectrum β-lactamase as an example
Objective Bacterial resistance is a pervasive and pressing public health issue worldwide that poses a significant threat to both healthcare and economies.This study aimed to provide a comprehensive analysis of the health and economic burden caused by Escherichia coli infections that produced extended-spectrum β-lactamases(ESBLs)from the hospital perspective in order to provide empirical evidence for the evaluation and optimization of policy interventions related to antibiotic resistance.Methods The study selected a sample from 170,819 admissions discharged from a tertiary hospital in Jiangxi Province during 2018-2019.The sample was divided into three groups:the ESBLs-positive infection group,the ESBLs-negative infection group,and the non-infection and colonized group.Propensity score matching(PSM)was employed to match the three groups at a 1∶1∶100 ratio.Cox's proportional hazards regression model and multi-state model were used to measure the hazard ratio(HR)of death and the number of extra bed days in the ESBLs-positive infected group relative to the two control groups,respectively.Finally,the cost of extra hospitalization based on the hospital perspective was calculated.Results A matched sample of 885,885,and 81,245 admissions was included in the analysis for the ESBLs-positive,ESBLs-negative,and non-infected and colonized groups,respectively.The study found that the HR of death in the ESBLs-positive group was 2.58 times greater than in the non-infected group(P＜0.001)and did not significantly increase the HR of death compared to those with ESBLs-negative infection(P=0.25).Furthermore,the ESBLs-positive group generated 3.69 and 1.92 additional bed days per case compared to its non-infected and ESBLs-negative counterparts,respectively.This corresponded to additional hospital costs of ¥6,570.12 and ¥3,418.60 per case.Conclusion ESBLs-producing Escherichia coli infections significantly increased the risk of death,prolonged hospitalization,and imposed substantial financial burdens on patients.Measures should be taken to prevent and control ESBLs infections.
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