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 careNosocomialE. coli and K. pneumoniae33/66aLOSCases, 1.76 times greater duration1.17-2.6442
Increased costCases, 2.90 times higher cost1.76-4.78
    Case-controlTertiary careBSIK. pneumoniae44/118aLOSCases, 39.6 days; controls, 23.9 daysP < 0.00838
    Case-controlMulticenterNosocomialK. pneumoniae9/9MortalityCases, 44%; controls, 33%P > 0.059
LOSCases, 37 ± 25 days; controls, 15 ± 10 daysP = 0.04
    Case-controlTertiary carePeritonitis (CAPDb)E. coli11/77MortalityCases, 27.3%; controls, 3.9%P = 0.0283
    Retrospective cohortTertiary careBSIEnterobacteriaceae99/99aLOSCases, 1.56 greater durationP = 0.00168
Increased costCases, 1.57 times higher costP = 0.003
    Retrospective cohortTertiary careNon-urinary tractE. coli and Klebsiella spp.21/21aMortalityCases, 8%; controls, 14%P = 0.18244
LOSCases, 21 days; controls, 11 daysP = 0.006
Increased costAttributable cost, $16,450$965-31,937
    Retrospective cohortTertiary careBSIK. pneumoniae46/82aMortalityORc for death in cases, 2.661.07-6.5976
LOSCases, 22 days; controls, 16 daysP = 0.03
    Prospective cohortTertiary careBSIE. coli46/308aMortalityOR for death in cases, 3.571.48-8.6047
Studies showing no impact of resistance
    Case-controlTertiary careNosocomialEnterobacteriaceae23/174MortalityCases, 26%; controls, 16%P = 0.1418
    Case-controlTertiary careNosocomialK. pneumoniae60/60a,dMortalityCases, 30%; controls, 28.3%P = 0.084133
    Case-controlTertiary careNosocomialEnterobacteriaceae31/39MortalityCases, 3.0%; controls, 2.4%P > 0.0513
    Case-controlTertiary careBSIE. coli and35/105aLOSCases, 8.2 additional daysP = 0.18284
Klebsiella spp.
    Retrospective cohortTertiary careNosocomialK. pneumoniae68/75aMortalityRRe, 0.940.45-1.9728
    Prospective cohortMulticenterBSI or pneumoniaEnterobacteriaceae135/40MortalityCases, 5.2%; controls, 12.5%P = 0.154
  • 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.