%0 Systematic Review
%T Excess resource use and cost of drug-resistant infections for six key pathogens in Europe: a systematic review and Bayesian meta-analysis.
%A Kingston R
%A Vella V
%A Pouwels KB
%A Schmidt JE
%A Abdelatif El-Abasiri RA
%A Reyna-Villasmil E
%A Hassoun-Kheir N
%A Harbarth S
%A Rodríguez-Baño J
%A Tacconelli E
%A Arieti F
%A Gladstone BP
%A de Kraker MEA
%A Naylor NR
%A Robotham JV
%A  
%J Clin Microbiol Infect
%V 30
%N 0
%D 2024 Mar 19
%M 38128781
%F 13.31
%R 10.1016/j.cmi.2023.12.013
%X <B>BACKGROUND: </B>Quantifying the resource use and cost of antimicrobial resistance establishes the magnitude of the problem and drives action.<BR><B>OBJECTIVE: </B>Assessment of resource use and cost associated with infections with six key drug-resistant pathogens in Europe.<BR><B>METHODS: </B>A systematic review and Bayesian meta-analysis.<BR><B>METHODS: </B>MEDLINE (Ovid), Embase (Ovid), Econlit databases, and grey literature for the period 1 January 1990, to 21 June 2022.<BR><B>METHODS: </B>Resource use and cost outcomes (including excess length of stay, overall costs, and other excess in or outpatient costs) were compared between patients with defined antibiotic-resistant infections caused by carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, CR or third-generation cephalosporin Escherichia coli (3GCREC) and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus faecium, and patients with drug-susceptible or no infection.<BR><B>METHODS: </B>All patients diagnosed with drug-resistant bloodstream infections (BSIs).<BR><B>METHODS: </B>NA.<BR><B>UNASSIGNED: </B>An adapted version of the Joanna Briggs Institute assessment tool, incorporating case-control, cohort, and economic assessment frameworks.<BR><B>UNASSIGNED: </B>Hierarchical Bayesian meta-analyses were used to assess pathogen-specific resource use estimates.<BR><B>RESULTS: </B>Of 5969 screened publications, 37 were included in the review. Data were sparse and heterogeneous. Most studies estimated the attributable burden by, comparing resistant and susceptible pathogens (32/37). Four studies analysed the excess cost of hospitalization attributable to 3GCREC BSIs, ranging from -€ 2465.50 to € 6402.81. Eight studies presented adjusted excess length of hospital stay estimates for methicillin-resistant S. aureus and 3GCREC BSIs (4 each) allowing for Bayesian hierarchical analysis, estimating means of 1.26 (95% credible interval [CrI], -0.72 to 4.17) and 1.78 (95% CrI, -0.02 to 3.38) days, respectively.<BR><B>CONCLUSIONS: </B>Evidence on most cost and resource use outcomes and across most pathogen-resistance combinations was severely lacking. Given the importance of this evidence for rational policymaking, further research is urgently needed.