Length of hospital stay and associated treatment costs for patients with susceptible and antibiotic-resistant Salmonella infections: systematic review and meta-analysis

Abstract

Abstract Background The global disease burden of Salmonella infections in 2017 included 135,900 deaths caused by Salmonella Typhi and Paratyphi and 77,000 deaths caused by invasive non-typhoidal Salmonella, and increasing antimicrobial resistance further exacerbates morbidity, mortality, and costs. To address the evidence gap on the economic burden of antimicrobial resistant Salmonella infections, our study aim is to estimate the estimate the length of hospital stay and associated treatment costs for patients with susceptible or antibiotic-resistant Salmonella Typhi, Paratyphi, and non-typhoidal Salmonella infections. Methods We conducted a systematic review by searching EMBASE, Medline, Scopus, Hinari, and LILACS databases for studies published between January 1, 2005 and December 17, 2021, with no language restrictions. We identified studies that reported on length of hospital stay and associated treatment costs for patients with susceptible or antibiotic-resistant Salmonella Typhi, Paratyphi, and non-typhoidal Salmonella infections. We converted monetary costs to 2019 USD and pooled estimates by quantile level of GDP per capita using random effects meta-analysis. We assessed the quality of included studies using critical appraisal tools from the Joanna Briggs Institute. Results We included 26 studies in our systematic review, and the mean quality scores ranged from 0.55 to 1.00 across different study designs. Patients with drug-resistant Salmonella infections had significantly longer hospital stays, with an additional 0.5–2.2 days compared to drug-susceptible Salmonella infections. The direct hospitalisation costs for drug-resistant typhoidal Salmonella were 71–103% higher than for drug-susceptible typhoidal Salmonella infections in the same setting. The mean hospital stay was 5.9 days (95% CI: 4.4, 7.5) for drug-susceptible typhoidal Salmonella infections, while it was 7 days (95% CI: 4.7, 9.3) for resistant typhoidal Salmonella infections in the lowest income quintile. Conclusions While the length of hospital stay and associated treatment costs for patients with antibiotic-resistant Salmonella infections varied by pathogen, country, and resistance level, they were higher in comparison to antibiotic-susceptible Salmonella infections. However, evidence on length of hospital stay and treatment costs are lacking from typhoid-endemic regions of sub-Saharan Africa.