Mortality associated with third generation cephalosporin-resistance in Enterobacteriaceae infections: a multicentre cohort study in Southern China

Abstract

ABSTRACTBackgroundEmerging third generation cephalosporin-resistant Enterobacteriaceae (3GCR-EB) pose a global healthcare concern. We assessed excess mortality in patients infected with 3GCR-EB compared to patients infected with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCS-EB).MethodsThe study cohort comprised all inpatients with a community-onset or healthcare-associated infection caused by Enterobacteriaceae in three tertiary-care public hospitals in 2017. Excess in-hospital mortality was assessed using competing risk survival models, adjusting for baseline patient characteristics.ResultsOf 2,343 study patients (median age 60 years; 45.2% male), 1,481 (63.2%) had 3GCS-EB and 862 (36.8%) 3GCR-EB infection. 494 (57.0%) 3GCR-EB isolates were co-resistant to fluoroquinolones and 15 (1.7%) co-resistant to carbapenems. In-hospital mortality was similar in the 3GCS-EB and 3GCR-EB groups (2.4% vs. 2.8%; p=0.601). No increase in the hazard of in-hospital mortality was detected for 3GCR-EB infections compared to 3GCS-EB infections (sub-distribution hazard ratio [HR] 0.80; 95%CI, 0.41 - 1.55) in multivariable analysis adjusting for patient age, sex, intensive care admission, origin of infection and site of infection. Analysis of cause-specific hazards showed that 3GCR-EB infections significantly decreased the daily rate of hospital discharge (cause-specific HR=0.84; 95%CI, 0.76 - 0.92) thereby leading to lengthier hospitalizations.ConclusionThird-generation cephalosporin resistance in Enterobacteriaceae infection per se was not associated with increased in-hospital mortality in this study. However, 3GCR-EB infections were seen to place significant healthcare burden by increasing the length of hospitalization compared to 3GCS-EB infections.