Mortality and Length of Stay Associated With Community-Acquired Escherichia coli and Staphylococcus aureus Bloodstream Infections: An Observational Study in 9 Low- and Middle-Income Countries.
Hopkins J., Tosas-Auguet O., Waithira N., Painter C., Ling CL., Roberts T., Miliya T., Obeng-Nkrumah N., Opintan JA., Abbeyquaye EP., Hamers RL., Saharman YR., Sinto R., Karyanti MR., Ibrahim RF., Akech SO., Ashley EA., Douangnouvong A., Choumlivong K., Feasey NA., Kululanga D., Lissauer S., Karkey A., Kunwar N., Erakhaiwu JE., Okeke IN., Adebiyi I., Adekanmbi OA., Oduola AB., Ogunbosi BO., Ojifinni KA., Tongo OO., Ude IA., Aboderin AO., Adekanle O., Adeyemo AT., Edward SS., Osagie U., Nguyen HT., Pham TN., Van Tran G., Hoàng HTL., Trịnh TH., van Doorn HR., Turner P., Lee SJ.
BackgroundAntimicrobial resistance disproportionally affects low- and middle-income countries. We calculated the burden of resistant and susceptible Escherichia coli and Staphylococcus aureus bloodstream infections (BSIs) in ACORN2, a prospective clinical surveillance study in adults and children.MethodsPatients with culture-confirmed community-acquired susceptible and resistant E. coli (third-generation cephalosporin susceptible [3GC-S] and resistant [3GC-R]) and S. aureus (methicillin-resistant [MRSA] and methicillin-susceptible [MSSA]) BSIs were compared against blood culture-negative patients (controls). Cause-specific hazard ratios (HRs) were calculated for competing events of in-hospital mortality and discharge alive. Length of hospital stay (LOS) was calculated.ResultsFrom 22 802 blood cultures taken, there were 329 E. coli (177 [53.8%] 3GC-R) and 363 S. aureus (132 [36.4%] MRSA) BSIs. In-hospital mortality was 8.4% for controls, 20.1% for E. coli (20.3% 3GC-R; 19.7% 3GC-S), and 13.1% for S. aureus (12.2% MRSA; 13.7% MSSA). 3GC-S but not 3GC-R E. coli BSI cases had higher adjusted hazard of death than controls (HRs, 1.73 [95% confidence interval {CI}, 1.20-2.49] and 1.38 [95% CI, .99-1.94]); risk of dying was the same for 3GC-S compared with 3GC-R infections (P = .882). Neither MSSA nor MRSA BSI patients were more likely to die than controls (HRs, 1.33 [95% CI, .91-1.93] and 1.00 [95% CI, .61-1.66]) nor MSSA versus MRSA (P = .891). The hazard of discharge alive for both resistant and susceptible S. aureus and E. coli decreased significantly when compared with controls. LOS was 2 (95% CI, 0-3) days and 1 (95% CI, -1 to 3) day longer for resistant compared with susceptible infections, for E. coli and S. aureus.ConclusionsAntimicrobial-resistant infections were not associated with increased mortality in ACORN2. Drug-resistant BSI had longer LOS compared with susceptible infections, but CIs encompassed 0 days.