Study finds substantial costs, extended hospital stays from C diff
A population-based analysis indicates that hospital-acquired Clostridioides difficile infection (HA-CDI) is associated with millions of dollars in attributable costs and with extended hospital stays, Canadian researchers reported today in Infection Control and Hospital Epidemiology.
In a multicenter, propensity-score–matched cohort study, researchers from the University of Calgary and Alberta Health Services compared adult inpatients at 14 Alberta hospitals who had developed HA-CDI with adult inpatients who had not developed HA-CDI, using data available from April 2012 through March 2016. The outcomes were attributable costs and length of stay at the hospital where HA-CDI was identified.
The mean adjusted costs of HA-CDI cases was $83,155 (USD $64,178), compared with $12,465 (USD $9,620) for non-cases, with HA-CDI cases incurring more costs across all categories and having longer stays. Of the 2,916 HA-CDI cases at facilities with microcosting data available, 2,871 were matched to 13,024 non-cases. Adjusted outcomes after matching showed that the total adjusted cost among HA-CDI cases was 27% greater than non-cases (ratio, 1.27; 95% confidence interval [CI], 1.21 to 1.33). The mean attributable cost of a typical HA-CDI case was $18,386 (USD $14,190). The adjusted length of stay among HA-CDI cases was 13% longer than non-cases (ratio, 1.13; 95% CI 1.07 to 1.19), corresponding to an extra 5.6 days in the hospital.
Extrapolating those results to the entire cohort of HA-CDI cases that occurred in Alberta during the study period, the burden to the healthcare system was an additional 5,856 hospital days and an excess of $19,227,379 (USD $14,839,376) per year on average.
The authors of the study conclude, "Our estimates will assist decision makers, healthcare providers, and patients in understanding the healthcare system burden of disease, justifying expenditures in intervention efforts and policies related to infection prevention and control, evaluating program effectiveness, determining allocation of research funding, and assessing the potential cost savings or bed days saved due to prevented infections."
Jul 25 Infect Control Hosp Epidemiol abstract
MCR-1, MCR-3–carrying E coli reported in New Zealand
Researchers from New Zealand yesterday reported the identification of the colistin-resistance genes MCR-1 and MCR-3 in a clinical Escherichia coli isolate. The findings were published in the Journal of Antimicrobial Chemotherapy.
The isolate, one of 23 clinical randomly collected in New Zealand from 2015 through 2018 and tested for colistin susceptibility, was from a woman in her late 60s with a spinal cord injury who was being treated for a urinary tract infection (UTI). Antimicrobial susceptibility testing showed that the isolate was resistant to multiple classes of antibiotics, and multilocus sequence typing identified it as belonging to ST101, an E coli sequence type found infrequently in New Zealand. Whole-genome sequencing located the MCR-1 and MCR-3 genes on separate plasmids, along with other antibiotic resistance genes, including blaCTX-M-55.
Further inquiry revealed the patient had traveled to Thailand 4 months prior to her UTI, and the researchers suspect that the MCR-1 and MCR-3–carrying E coli was likely acquired there, since MCR-3 and blaCTx-M-55 have links to Thailand.
To date, only two other clinical isolates carrying both MCR-1 and MCR-3—a Salmonella isolate and an E coli isolate—have been reported.
Jul 24 J Antimicrob Chemother abstract
Resistant Pseudomonas death in Utah linked to surgery in Mexico
A Utah resident who died after traveling to Tijuana, Mexico, for weight-loss surgery tested positive for a multidrug-resistant form of Pseudomonas aeruginosa, according to a news release from the Utah Department of Health (UDOH).
The patient was one of eight Utah residents who tested positive for Verona integron-encoded metallo-beta-lactamase–producing carbapenem-resistant P aeruginosa (VIM-CRPA) after getting weight-loss surgery in Tijuana. Interviews with patients or their family members revealed that seven of the eight patients had the same surgeon.
The Utah VIM-CRPA cases are linked to similar cases that have been reported to state health departments and the Centers for Disease Control and Prevention (CDC) since September 2018. On May 24, the CDC reported that 12 VIM-CRPA cases with links to surgical procedures in Mexico had been identified in seven states. Eleven of the 12 patients reported having bariatric surgery at five hospitals in Mexico. Six of the patients were subsequently hospitalized in the United States for their infection, and one died.
UDOH said individuals who had a surgical procedure in Tijuana during or after August 2018 and are experiencing signs of infection—including fever, redness, drainage from the surgical site, or swelling at the surgical site—should seek immediate medical care. The department is also recommending that residents not travel to Mexico for invasive surgical procedures.
"I cannot stress enough the safest course of action is not to travel to Mexico for these procedures," Allyn Nakashima, MD, manager of the UDOH Healthcare-Associated Infections/Antimicrobial Resistance Program, said. "Using an internationally accredited facility is not a guarantee that your medical care will be free of complications."
Jul 22 UDOH news release
May 23 CIDRAP News stewardship/resistance scan