How Does Antimicrobial Resistance Increase Medical Costs in Community-Acquired Acute Pyelonephritis?

抗菌素耐药性如何增加社区获得性急性肾盂肾炎的医疗成本？

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作者：Sansom,Sarah E,Gussin,Gabrielle M,Singh,Raveena D,Bell,Pamela B,Benson,Ellen,Makhija,Jinal,Froilan,Mary Carl,Saavedra,Raheeb,Pedroza,Robert,Thotapalli,Christine,Fukuda,Christine,Gough,Ellen,Marron,Stefania,Villanueva Guzman,Maria Del Mar,Shimabukuro,Julie A,Mikhail,Lydia,Black,Stephanie,Pacilli,Massimo,Adil,Hira,Bittencourt,Cassiana E,Zahn,Matthew,Moore,Nicholas,Sexton,D,Noble-Wang,Judith,Lyman,Meghan,Lin,Michael,Huang,Susan,Hayden,Mary K,Garrod,Matthew,Short,Katy,Zlosnik,James,Prystajecky,Natalie,Miwa,Toshiki,Takamatsu,Akane,Honda,Hitoshi,Cohen,Stuart,Louie,Thomas,Berenson,Charles,Amin,Alpesh,Lombardi,David,Pham,Sissi,Huang,Shirley,Wang,Elaine,Hasson,Brooke,McGovern,Barbara,Von Moltke,Lisa,Cohen,Amy,Erwes,Thomas,Wiskirchen,Dora,Abrantes-Figueiredo,Jessica,Witt,Lucy,Howard-Anderson,Jessica,Overton,Elizabeth,Jacob,Jesse,Stancill,Lisa,DiBiase,Lauren,Vavalle,Emily Sickbert-Bennett,Ouedraogo,Youssoufou,Evans,Christopher,Muleta,Daniel,Wilson,Christopher,Goff,Debra,Mangino,Julie,Trolli,Elizabeth,Goff,Douglas,Charles Fil de Lara,Fortune,Mano,Maria Jesusa,Henson,Karl Evans,Bello,Jia An,Abad,Cybele Lara,Priem,Jennifer,Krinner,Lisa,Murphy,Stephanie,Monahan,Sveta,Hole,Colleen,Huang,Felicia Scaggs,Ankrum,Andrea,Hospital,Cincinnati,Teoh,Zheyi,Courter,Joshua,Francesco,Mangano,Bierbrauer,Karin,Josh,Hasegawa,Shinya,Kakiuchi,Satoshi,Livorsi,Daniel,Perencevich,Eli,Goto,Michihiko,Kakiuchi,Satoshi,Perencevich,Eli,Livorsi,Daniel,Goto,Michihiko,Fofanah,Bobson,Tengbe,Sia,Kamara,Ibrahim,Korjie,Musa M,Kang,Minji,Conrad,Zane,Thomas,Elizabeth,Arocha,Doramarie,Trivedi,Julie,Hojat,Leila,Wilson,Brigid,Perez,Federico,Bonomo,Robert,Elliott,Rachel,Shaw,Jana,Suits,Paul,Fetibegovic,Emina,Stewart,Telisa,Wong,Roger,Briggs,Julie,Ryan,Tenley,Thomas-Gosain,Neena,Eason,Jane,Akalu,Hanna,Sharif,Navila,Bennett,Jessica,Kamara,Rugiatu Z,Foster,Monique,Weiss,Jamine,Conteh,Christiana,Munsiff,Sonal,Sakai,Alexandra,Dumyati,Ghinwa,Chitavi,Salome,Kohut,Mike,Braun,Barbara,Adams,Meghann,Hyun,David,Spicer,Lori,Campbell,Davina,Johnson,J Kristie,Longo,Cynthia,Balbuena,Thomas,Ewing,Thomas,Karlsson,Maria,Rasheed,J Kamile,Elkins,Christopher,Gargis,Amy,Lutgring,Joseph,Jones,DeShauna,Marra,Alexandre,Livorsi,Daniel,Perencevich,Eli,Goto,Michihiko,Most,Zachary,Sebert,Michael,Perl,Trish,Rhee,Yoona,Hayden,Mary,Schoeny,Michael,Fukuda,Christine,Bell,Pamela B,Simms,Andrew,Sha,Beverly,Santos,Carlos,Lin,Michael,Kim,EunJo,Kang,JaHyun,Stampke,Lisa Corley,Osborn,Jessica,Guzman-Cottrill,Judith,Poole,Nicole,Dorsey-Holliman,Brooke,Anderson,Leisha,O’Leary,Sean,Glaros,Chloe,Alban,Jessica,Burke,Patrick,Sitaras,Joanne,Fraser,Thomas,Coury,Elias,Dietz,Shannon,Cazals,Margot,Bedard,Emilie,Prévost,Michèle,Savard,Patrice,Penney,Jessica,Rodday,Angie,Sebastiani,Paola,Snydman,David,Doron,Shira,Cassone,Marco,Wang,Joyce,Lansing,Bonnie,Mantey,Julia,Gibson,Kristen,Gontjes,Kyle,Mody,Lona,Simon,Samantha,Sater,Mohamad,Herriott,Ian,Huntley,Miriam,Hollenbeck,Brian,DiTullio,David,Takats,Courtney,Hochman,Sarah,Hsueh,Leon,Uslan,Daniel,De St. Maurice,Annabelle,Schulz-Stubner,Sebastian,Sundermann,Alexander,Griffith,Marissa,Srinivasa,Vatsala Rangachar,Waggle,Kady,Saul,Melissa,Ayres,Ashley,Snyder,Graham,Marsh,Jane,Harrison,Lee,Seidelman,Jessica,Lewis,Sarah,Kalu,Ibukun,Gettler,Erin,Advani,Sonali,Anderson,Deverick,Smith,Becky,Navalkele,Bhagyashri,Winn,Wendy,Fletcher,Sheila,Galloway,Regina,Parham,Jason,Daley,William,Kyle,Patrick,Clack,Vonda,Sheilds,Kathy,Bennett,William,Prince,Steven,Zeman,Kirby,Samet,James,Mongilardi,Nicole,Wilson,Brigid,Bej,Taissa,Song,Sunah,Jump,Federico,Perez,Federico,Akpoji,Ukwen,Chan,Hwang Ching,Ang,Alicia,Fauzi,Nazira,Sridhar,Revathi,Poh,Annie,Low,Isaac,Fisher,Dale,Tambyah,Paul,Somani,Jyoti,Breeden,Maddy,Scruggs,Elizabeth,Patel,Payal,Krein,Sarah,Kendall,Ronald,Starnes,Andrea,Lopus,Tracy,Adre,Cullen,Ouedraogo,Youssoufou,Evans,Christopher,Wilson,Christopher,Clark,Sophie,Bautista,Liza Marie,Neeb,Karen,Montoya,Ana,Gibson,Kristen,Mantey,Julia,Min,Lillian,Mody,Lona,Hogle,Nancy,Burke,Patrick,Fraser,Thomas,Bischoff,Werner,Ornelles,David,Ivey,Lauren,Payne,Bill,Livorsi,Daniel,Perencevich,Eli,Stewart Steffensmeier,Kenda,Goetz,Matthew,Reisinger,Heather,Sifri,Costi,Buckner,Joan,Shelton,Cady,Vang,Kheng,Smith,Graham,Pastoor,Sara J,Fontaine,Garrett,Banach,David,Aeschlimann,Jeffrey,Saidel,Lisa,Borer,Abraham,Sagi,Orli,Norris,Ashlyn,Northam,Kalynn,Daniels,Lindsay,Kwan,Mildred,Burke,Gary,Mavrogiorgos,Nikolaos,Boerneke,Renae,Lou Manning,Mary,Pogorzelska-Maziarz,Monika,Jack,David,Wheeler,Lori,Clarke,Erik,Geurtsen,Jeroen,Spiessens,Bart,Chehoud,Christel,Estrada,Leah,Dick,Andrew,Stone,Patricia,Harrison,Jordan,Engeda,Joseph,Kriengkauykiat,Jane,Epson,Erin,Barnett,William,Holtzapple,Zachary,Assaly,Ragheb,Chiang,Leslie,Pong,Alice,Bradley,John,Anderson,Paige,Murray,William,Kobayashi,Takaaki,Alsuhaibani,Mohammed,Ortiz,Miguel,Imborek,Katherine,Holley,Stephanie,Trannel,Alexandra,Marra,Alexandre,Etienne,William,Jenn,Kyle,Abosi,Oluchi,Meacham,Holly,Sheeler,Lorinda,Dains,Angie,Kukla,Mary,McCray,Paul,Perlman,Stanley,Ford,Bradley,Diekema,Daniel,Wellington,Melanie,Pezzulo,Alejandro,Salinas,Jorge,Hawes,Armani,Patel,Payal,Desai,Angel,Navalkele,Bhagyashri,Fletcher,Sheila,Martin,Sanjosa,Galloway,Regina,Palmer,April,Parriott,Andrea,Kazerouni,N Neely,Epson,Erin,Keehner,Jocelyn,Torriani,Francesca,Abeles,Shira,Horton,Lucy,Gleason-Vergados,Johanna,Banach,David,Clogher,Paula,Meek,James,Biggio,Adriane,Nagy-Agren,Stephanie,Braun,Barbara,Chitavi,Salome,Stenehjem,Eddie,Khan,Mushira,Baker,David,Hyun,David,Bej,Taissa,Wilson,Brigid,Song,Sunah,Briggs,Janet M,Banks,Richard,Kothadia,Sonya,Perez,Federico,Jump,Robin,Mongilardi,Nicole,Mestrovic,Tomislav,Bedenic,Branka,Tomic-Paradzik,Maja,Drenjancevic,Domagoj,Spencer,Hillary,Banerjee,Ritu,Wilson,Gregory,Boswell,Tanya,Warren,Bobby,Moehring,Rebekah,Yarrington,Michael,Anderson,Deverick,Polage,Christopher,Alsuhaibani,Mohammed,Kobayashi,Takaaki,Sheeler,Lorinda,Trannel,Alexandra,Holley,Stephanie,Abosi,Oluchi,Jenn,Kyle,Meacham,Holly,Etienne,William,Dains,Angie,Kukla,Mary,Millard,Bill,Marra,Alexandre,Wellington,Melanie,Diekema,Daniel,Salinas,Jorge,Midori,Valeria,Yuki,Gutoski,Rocha,Patricia,Decarli,Ariadne,Esteves,Larissa,Nascimento,Laís,Tuon,Felipe,Ribeiro,Victoria,Cieslinski,Juliette,Dodson,Daniel,Kronman,Matthew,Parker,Sarah,Czaja,Christopher,Lanjewar,Swapnil,Kates,Ashley,Watson,Lauren,Safdar,Nasia,Kwon,Taesung,Kenyon,Stacy,Kilheeney,Kimberly,Martin,Stanley,Shelly,Mark,Reynolds,Staci,Keating,Edward,Kriengkauykiat,Jane,Epson,Erin,Garcia,Erin,Komaiko,Kiya,Johnson,Wesley,Burgess,David,Burgess,Donna,Cotner,Sarah,VanHoose,Jeremy,Clark,Justin,Wallace,Katie,Lin Ling,Moi,How,Molly,Yuen Tan,Kwee,Wee,Elaine,Poh Choo,Phoon,Chee Lee,Lai,Evans,Kenisha,LeRose,Jennifer,Beatriz Cruz,Angela,Jabbo,Lavina,Chopra,Teena,Dutcher,Lauren,Bediako,Hilary,Harker,Christina,Rao,Aditi,Sigafus,Kristen,Hamilton,Keith,Fadugba,Olajumoke,Concha,Miguel Chavez,Hsueh,Kevin,Durkin,Michael,Spec,Andrej,Pfeiffer,Yvonne,Atkinson,Andrew,Maag,Judith,Lane,Michael,Schwappach,David,Marschall,Jonas,Mestrovic,Tomislav,Talapko,Jasminka,Cikac,Tina,Neuberg,Marijana,Szymczak,Julia,Muller,Brandi,Shakamuri,Nikitha,Hamilton,Keith,Dodds Ashley,Elizabeth,Babcock,Hilary,Moehring,Rebekah,Newland,Jason,Lautenbach,Ebbing,Kim,Bongyoung,Cheong,Taul,Ahn,Jungmo
期刊：Antimicrobial Stewardship Healthcare Epidemiology影响因子：1.800
时间：2021起止号：2021 Jul;1(Suppl 1):s23
doi：10.1017/ash.2022.306

Abstract

Background: The proportion of antimicrobial-resistant Enterobacterales that are causative pathogens for community-acquired acute pyelonephritis (CA-APN) has been increasing. We examined the effect of antimicrobial resistance on medical costs in CA-APN. Methods: A single-center retrospective cohort study was conducted at a tertiary-care hospital in Korea between January 2018 to December 2019. All hospitalized patients aged ≥19 years who were diagnosed with CA-APN were recruited, and those with Enterobacterales as a causative pathogen were included. Comparisons between CA-APN caused by extended-spectrum β-lactamase (ESBL)–producing pathogens (ESBL+ group) and those by non–ESBL-producing organisms (ESBL– group) as well as CA-APN caused by ciprofloxacin-resistant pathogens (CIP-R group) and those by ciprofloxacin-sensitive pathogens (CIP-S group) were performed. Log-linear regression was performed to determine the risk factors for medical costs. Results: In total, 241 patients were included in this study. Of these, 75 (31.1%) had an ESBL-producing pathogen and 87 (36.1%) had a ciprofloxacin-resistant pathogen. The overall medical costs were significantly higher in the ESBL+ group compared with the ESBL− group (US$3,730.18 vs US$3,119.32) P <0.001) as well as in CIP-R group compared with CIP-S group (3,730.18 USD vs. 3,119.32 USD, P =0.005). In addition, length of stay was longer in ESBL+ group compared with ESBL-group (11 vs. 8 days, P <0.001) as well as in CIP-R group compared with CIP-S group (11 vs. 8 days, P <0.001). There were no significant difference in the proportion of clinical failure between ESBL+ and ESBL- groups; CIP-R and CIP-S groups. Based on the log-linear regression model, the costs associated with ESBL-producing Enterobacterales as the causative pathogen would be, on average, 27% higher or US$1,211 higher than its counterpart (P = .026). By the same token, a patient who is a year older would incur US$23 higher cost (P = .040). Having any structural problem in urinary tract would incur US$1,231 higher cost (P = .015). A unit increase in Pitt score would incur US$767 USD higher cost (P < 0.001) higher cost, all other things constant. Conclusions: Medical costs for hospitalized patients with CA-APN are increased by the existence of ESBL-producing Enterobacterales but not by the existence of ciprofloxacin-resistant Enterobacterales. Funding: No Disclosures: None

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