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Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis

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  • Miquel Serra-Burriel
  • Matthew Keys
  • Carlos Campillo-Artero
  • Antonella Agodi
  • Martina Barchitta
  • Achilleas Gikas
  • Carlos Palos
  • Guillem López-Casasnovas

Abstract

Background: Infections with multidrug resistant (MDR) bacteria in hospital settings have substantial implications in terms of clinical and economic outcomes. However, due to clinical and methodological heterogeneity, estimates about the attributable economic and clinical effects of healthcare-associated infections (HAI) due to MDR microorganisms (MDR HAI) remain unclear. The objective was to review and synthesize the evidence on the impact of MDR HAI in adults on hospital costs, length of stay, and mortality at discharge. Methods and findings: Literature searches were conducted in PubMed/MEDLINE, and Google Scholar databases to select studies that evaluated the impact of MDR HAI on economic and clinical outcomes. Eligible studies were conducted in adults, in order to ensure homogeneity of populations, used propensity score matched cohorts or included explicit confounding control, and had confirmed antibiotic susceptibility testing. Risk of bias was evaluated, and effects were measured with ratios of means (ROM) for cost and length of stay, and risk ratios (RR) for mortality. A systematic search was performed on 14th March 2019, re-run on the 10th of June 2019 and extended the 3rd of September 2019. Small effect sizes were assessed by examination of funnel plots. Sixteen articles (6,122 patients with MDR HAI and 8,326 patients with non-MDR HAI) were included in the systematic review of which 12 articles assessed cost, 19 articles length of stay, and 14 mortality. Compared to susceptible infections, MDR HAI were associated with increased cost (ROM 1.33, 95%CI [1.15; 1.54]), prolonged length of stay (ROM 1.27, 95%CI [1.18; 1.37]), and excess in-hospital mortality (RR 1.61, 95%CI [1.36; 1.90]) in the random effects models. Risk of publication bias was only found to be significant for mortality, and overall study quality good. Conclusions: MDR HAI appears to be strongly associated with increases in direct cost, prolonged length of stay and increased mortality. However, further comprehensive studies in this setting are warranted. Trial registration: PROSPERO (CRD42019126288).

Suggested Citation

  • Miquel Serra-Burriel & Matthew Keys & Carlos Campillo-Artero & Antonella Agodi & Martina Barchitta & Achilleas Gikas & Carlos Palos & Guillem López-Casasnovas, 2020. "Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-14, January.
    • Handle: RePEc:plo:pone00:0227139
    DOI: 10.1371/journal.pone.0227139
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    References listed on IDEAS

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    1. Christopher F. Higgins, 2007. "Multiple molecular mechanisms for multidrug resistance transporters," Nature, Nature, vol. 446(7137), pages 749-757, April.
    2. Ansgar Resch & Michael Wilke & Christian Fink, 2009. "The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 287-297, July.
    3. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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