Costs and Outcomes of 1-year post-discharge care trajectories of patients admitted with infection due to antibiotic-resistant bacteria.

Aftercare Anti-Bacterial Agents / therapeutic use Bacteria Hospital Costs Hospitalization Humans Length of Stay Patient Discharge
Administrative database Antimicrobial resistance Sequence analysis

Journal

The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424

Informations de publication

Date de publication:
03 2021
Historique:
received: 09 09 2020
revised: 11 12 2020
accepted: 01 02 2021
pubmed: 9 2 2021
medline: 24 4 2021
entrez: 8 2 2021
Statut: ppublish

Résumé

The impact of antibiotic resistance (AMR) on initial hospital management has been extensively studied but its consequences after hospital discharge remain largely unknown. We aimed to analyze hospital care trajectories, cumulative length of hospital stays (c-LOS) and associated costs of care over a 1-year period after hospitalization with incident AMR infection. All incident bacterial infection-related hospitalizations occurring from January 1, 2015, to December 31, 2015 and recorded in the French national health data information system were extracted. Bacterial resistance ICD-10 codes determined six infection status. Inpatient and outpatient care consumption and associated costs were studied. The impact of resistance on c-LOS was estimated using a Poisson regression. A sequence analysis through optimal matching method was conducted to identify hospital trajectories along with an extrapolation. Of the 73,244 patients selected, 15.9% had AMR infection, thus providing 58,286 incident AMR infections after extrapolation. c-LOS was significantly longer for infections with resistant bacteria, reaching 20.4 days and 2.9 additional days IC95%[2.6; 3.2] for skin and soft tissue infections. An estimated 29,793 (51.1%) patients had hospital readmission within the following year, for a total cost of €675 million. Five post-discharge trajectories were identified: Post-hospitalization mainly at home (68.4% of patients); Transition to home from rehabilitation care (12.3%); Early death (<3 months) (9.7%); Late death (7.4%), and Long-term hospitalization (2.2%). AMR has an impact on patients' c-LOS stay beyond the initial hospitalization. Half of patients hospitalized due to AMR are readmitted to hospital within the ensuing year, along five different trajectories. French Ministry of health.

Sections du résumé

BACKGROUND
The impact of antibiotic resistance (AMR) on initial hospital management has been extensively studied but its consequences after hospital discharge remain largely unknown. We aimed to analyze hospital care trajectories, cumulative length of hospital stays (c-LOS) and associated costs of care over a 1-year period after hospitalization with incident AMR infection.
METHOD
All incident bacterial infection-related hospitalizations occurring from January 1, 2015, to December 31, 2015 and recorded in the French national health data information system were extracted. Bacterial resistance ICD-10 codes determined six infection status. Inpatient and outpatient care consumption and associated costs were studied. The impact of resistance on c-LOS was estimated using a Poisson regression. A sequence analysis through optimal matching method was conducted to identify hospital trajectories along with an extrapolation.
FINDING
Of the 73,244 patients selected, 15.9% had AMR infection, thus providing 58,286 incident AMR infections after extrapolation. c-LOS was significantly longer for infections with resistant bacteria, reaching 20.4 days and 2.9 additional days IC95%[2.6; 3.2] for skin and soft tissue infections. An estimated 29,793 (51.1%) patients had hospital readmission within the following year, for a total cost of €675 million. Five post-discharge trajectories were identified: Post-hospitalization mainly at home (68.4% of patients); Transition to home from rehabilitation care (12.3%); Early death (<3 months) (9.7%); Late death (7.4%), and Long-term hospitalization (2.2%).
INTERPRETATION
AMR has an impact on patients' c-LOS stay beyond the initial hospitalization. Half of patients hospitalized due to AMR are readmitted to hospital within the ensuing year, along five different trajectories.
FUNDING
French Ministry of health.

Identifiants

DOI: 10.1016/j.jinf.2021.02.001 PMID: 33556428
pubmed: 33556428
pii: S0163-4453(21)00052-9
doi: 10.1016/j.jinf.2021.02.001
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

339-345

Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

Mehdi Touat (M)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.

Christian Brun-Buisson (C)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.

Marion Opatowski (M)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.

Jérôme Salomon (J)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France; Assistance Publique/Hôpitaux de Paris, Raymond-Poincaré Hospital, 104 Boulevard Raymond Poincaré, Garches, France.

Didier Guillemot (D)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France; Assistance Publique/Hôpitaux de Paris, Raymond-Poincaré Hospital, 104 Boulevard Raymond Poincaré, Garches, France.

Philippe Tuppin (P)

Department of Studies on Patients and Diseases, CNAM (National Health Insurance), 50 Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France.

Grégoire de Lagasnerie (G)

Department of Health Products, CNAM (National Health Insurance), 50 Avenue du Professeur André Lemierre, 75986 Paris Cedex 20, France.

Laurence Watier (L)

Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France. Electronic address: laurence.watier@inserm.fr.

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Classifications MeSH

questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Post-cure › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Bactéries › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Coûts des soins de santé › Coûts hospitaliers › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Costs and Outcomes of 1-year post-discharge...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Costs and Outcomes of 1-year post-discharge...