Impact of septic episodes caused by Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa in a tertiary hospital: clinical and economic considerations in years 2018-2020

OBJECTIVE

To evaluate incidence, therapy and antibiotic resistance trends in septic episodes caused by three multi-drug resistant bacteria in a tertiary hospital, by also estimating their economic impact.

METHODS

An observational, retrospective-cohort analysis was based on data related to patients admitted to the "SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (Italy) between 2018 and 2020, that developed sepsis from multi-drug resistant bacteria of the examined species. Data were retrieved from medical records and from the hospital's management department.

RESULTS

Inclusion criteria led to enrolment of 174 patients. A relative increase in A. baumannii cases (p < 0.0001) and an increasing resistance trend for K. pneumoniae (p < 0.0001) were detected in 2020 compared to 2018-2019. Most patients were treated with carbapenems (72.4%), although the use of colistin rose significantly in 2020 (62.5% vs 36%, p = 0.0005). Altogether, these 174 cases caused 3295 additional hospitalisation days (mean 19 days/patient): the consequent expenditure attained ≈ 3 million Euros, 85% of which (≈2.5 million Euros) due to the cost of extra hospital stay. Specific antimicrobial therapy accounted for 11.2% of the total (≈336,000 €).

CONCLUSIONS

Healthcare-related septic episodes cause a considerable burden. Moreover, a trend could be spotted towards higher relative incidence of complex cases recently.

Impact of sepses caused by three Multi-Drug Resistant bacteria in a tertiary hospital in 2018-2020

Background

Healthcare-associated infections represent a major health issue, particularly if caused by multi-drug resistant (MDR) microorganisms, with additional hospitalisation days and relevant costs besides illness and deaths. This study aimed at evaluating the economic impact of healthcare-related sepses caused by three MDR Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital.

Methods

An observational, retrospective-cohort analysis was based on data related to patients admitted to the “SS. Antonio e Biagio e Cesare Arrigo” Hospital in Alessandria (Italy) between 2018 and 2020. Starting from the microbiology laboratory database, the set of patients developing sepses from the examined species was selected, by also checking that the relevant antibiogram provided evidence of resistance to ≥ 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients’ medical records and from the hospital's computer-based application.

Results

In years 2018-2020, 174 patients developed septic infections from the examined species, the majority of which (88, i.e. 50.6%) in 2020 only. Altogether, these cases were responsible for 3,295 additional hospitalisation days (median 14 days, mean 19 days), with 901 imaging and 7,365 laboratory exams being reasonably ascribable to the septic episodes. Sepsis-related costs could be estimated in around 3 million Euros, about 85% of which (≈2.5 million Euros) were due to the actual cost of extra hospital stay. Specific antimicrobial therapy accounted for around 11.2% of the total (≈336,000 €).

Conclusions

The results of this study pointed out that MDR sepses were responsible for conspicuous costs, largely grounded on the extra length of hospital stays but also due to the use of highly-expensive new-generation antimicrobials. Further research is needed to explore costs of septic episodes in different contexts.

Key messages

• MDR sepses entailed high costs (around 3 million Euros in three years only in a single hospital), due to extra length of hospital stays and use of highly-expensive new-generation antimicrobials.

• In order to provide wider-scale estimates of the economic impact of sepses, further research is needed to explore costs of septic episodes in different sanitary systems and contexts.