TABLE 2.

Impact of extended-spectrum cephalosporin resistance in Enterobacteriaceae on mortality, LOS, and hospital cost

Type of studySettingType of infectionBacteriaNo. of cases/no. of controlsParameterMain findingsSignificance (P value or 95% CI)Reference
Studies showing an impact of resistance
    Case-controlTertiary careNosocomial E. coli and K. pneumoniae33/66aLOSCases, 1.76 times greater duration1.17-2.64 42
Increased costCases, 2.90 times higher cost1.76-4.78
    Case-controlTertiary careBSI K. pneumoniae 44/118aLOSCases, 39.6 days; controls, 23.9 days P < 0.008 38
    Case-controlMulticenterNosocomial K. pneumoniae 9/9MortalityCases, 44%; controls, 33% P > 0.05 9
LOSCases, 37 ± 25 days; controls, 15 ± 10 days P = 0.04
    Case-controlTertiary carePeritonitis (CAPDb) E. coli 11/77MortalityCases, 27.3%; controls, 3.9% P = 0.02 83
    Retrospective cohortTertiary careBSI Enterobacteriaceae 99/99aLOSCases, 1.56 greater duration P = 0.001 68
Increased costCases, 1.57 times higher cost P = 0.003
    Retrospective cohortTertiary careNon-urinary tract E. coli and Klebsiella spp.21/21aMortalityCases, 8%; controls, 14% P = 0.182 44
LOSCases, 21 days; controls, 11 days P = 0.006
Increased costAttributable cost, $16,450$965-31,937
    Retrospective cohortTertiary careBSI K. pneumoniae 46/82aMortalityORc for death in cases, 2.661.07-6.59 76
LOSCases, 22 days; controls, 16 days P = 0.03
    Prospective cohortTertiary careBSI E. coli 46/308aMortalityOR for death in cases, 3.571.48-8.60 47
Studies showing no impact of resistance
    Case-controlTertiary careNosocomial Enterobacteriaceae 23/174MortalityCases, 26%; controls, 16% P = 0.14 18
    Case-controlTertiary careNosocomial K. pneumoniae 60/60a, dMortalityCases, 30%; controls, 28.3% P = 0.0841 33
    Case-controlTertiary careNosocomialEnterobacteriaceae31/39MortalityCases, 3.0%; controls, 2.4% P > 0.05 13
    Case-controlTertiary careBSI E. coli and 35/105aLOSCases, 8.2 additional days P = 0.182 84
Klebsiella spp.
    Retrospective cohortTertiary careNosocomial K. pneumoniae 68/75aMortalityRRe, 0.940.45-1.97 28
    Prospective cohortMulticenterBSI or pneumonia Enterobacteriaceae 135/40MortalityCases, 5.2%; controls, 12.5% P = 0.15 4
  • a Studies with either matched controls or multivariate analysis, in order to minimize confounding.

  • b CAPD, continuous ambulatory peritoneal dialysis.

  • c OR, odds ratio.

  • d Matched controls.

  • e RR, risk ratio.