Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Guangzhou, China: risk factors and economic burden among Patients with bloodstream infections

Abstract Background. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae (ESBL-EK) are important sources of bloodstream infection (BSI), but their economic impact has not been comprehensively evaluated. Patients and methods. A retrospective analysis of inpatients diagnosed with Escherichia coli or Klebsiella pneumoniae bacteremia in tertiary hospitals between January 2020 and December 2022 was performed. Clinical data and healthcare spending were collected through a chart review of electronic medical records. The chi-square test was used to analyze risk factors for ESBL, and then propensity score matching (PSM) was used to match patients 1:1 ratio to eliminate confounding factors and economic burden was assessed using disability-adjusted life years (DALYs). Results. A total of 318 patients meeting study specifications were identified. Before matching, there were statistically significant differences in hospitalization time before infection, organ transplantation rate, ICU admission rate, Age-adjusted Charlson Comorbidity Index (ACCI), and SOFA score between the two groups (all p<0.05). After using PSM-adjusted estimates, the ESBL group still had a lower rate of effective empirical antimicrobial therapy than the non-ESBL group (non-ESBL=79.3% vs ESBL=59.5% p=0.001). The ESBL group had a higher hospitalization cost, but there was no significant difference in total mortality (non-ESBL=19.0% vs ESBL=20.7%, p=0.747) and mean DALYs (non-ESBL=1.84 DALYs vs ESBL=2.12 DALYs, p=0.098) between two groups. Mediation analysis identified that the relationship between ESBL and hospitalization costs is largely or fully mediated by inappropriate empirical antibiotic therapy and hospital stay. Conclusion. The cost of patients with BSI caused by ESBL-EK is higher than that of patients with BSI caused by non-ESBL-EK. This phenomenon can be attributed to differences in effective empirical antimicrobial therapy rates and length of hospitalization. Reasonable assessment of ESBL risk，fully consider the regional epidemiological situation and precise use of antibiotics are very important to reduce the burden on patients.