Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji

Michael J. Loftus; Tracey E.M.W. Young-Sharma; Sue J. Lee; Shitanjni Wati; Gnei Z. Badoordeen; Luke V. Blakeway; Sally M.H. Byers; Allen C. Cheng; Ben S. Cooper; Hugh Cottingham; Adam W.J. Jenney; Jane Hawkey; Nenad Macesic; Ravi Naidu; Amitesh Prasad; Vinita Prasad; Litia Tudravu; Timoci Vakatawa; Elke van Gorp; Jessica A. Wisniewski; Eric Rafai; Anton Y. Peleg; Andrew J. Stewardson

Journal of Global Antimicrobial Resistance (Sep 2022)

Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji

Michael J. Loftus,
Tracey E.M.W. Young-Sharma,
Sue J. Lee,
Shitanjni Wati,
Gnei Z. Badoordeen,
Luke V. Blakeway,
Sally M.H. Byers,
Allen C. Cheng,
Ben S. Cooper,
Hugh Cottingham,
Adam W.J. Jenney,
Jane Hawkey,
Nenad Macesic,
Ravi Naidu,
Amitesh Prasad,
Vinita Prasad,
Litia Tudravu,
Timoci Vakatawa,
Elke van Gorp,
Jessica A. Wisniewski,
Eric Rafai,
Anton Y. Peleg,
Andrew J. Stewardson

Affiliations

Michael J. Loftus: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Tracey E.M.W. Young-Sharma: Colonial War Memorial Hospital, Suva, Fiji
Sue J. Lee: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Shitanjni Wati: Colonial War Memorial Hospital, Suva, Fiji
Gnei Z. Badoordeen: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Luke V. Blakeway: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Sally M.H. Byers: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Allen C. Cheng: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Ben S. Cooper: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
Hugh Cottingham: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Adam W.J. Jenney: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Fiji National University, Suva, Fiji
Jane Hawkey: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Nenad Macesic: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Centre to Impact AMR, Monash University, Melbourne, Australia
Ravi Naidu: Colonial War Memorial Hospital, Suva, Fiji
Amitesh Prasad: Colonial War Memorial Hospital, Suva, Fiji
Vinita Prasad: Colonial War Memorial Hospital, Suva, Fiji
Litia Tudravu: Colonial War Memorial Hospital, Suva, Fiji
Timoci Vakatawa: Colonial War Memorial Hospital, Suva, Fiji
Elke van Gorp: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Jessica A. Wisniewski: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
Eric Rafai: Fiji Ministry of Health and Medical Services, Suva, Fiji
Anton Y. Peleg: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia; Alternative corresponding author. Mailing address: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne VIC 3004, Australia.
Andrew J. Stewardson: Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Corresponding author. Mailing address: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne VIC 3004, Australia.

Journal volume & issue: Vol. 30
pp. 286 – 293

Abstract

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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.

Published in Journal of Global Antimicrobial Resistance

ISSN: 2213-7165 (Print); 2213-7173 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Science: Microbiology
Website: https://www.journals.elsevier.com/journal-of-global-antimicrobial-resistance

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