{Reference Type}: Systematic Review
{Title}: Excess resource use and cost of drug-resistant infections for six key pathogens in Europe: a systematic review and Bayesian meta-analysis.
{Author}: Kingston R;Vella V;Pouwels KB;Schmidt JE;Abdelatif El-Abasiri RA;Reyna-Villasmil E;Hassoun-Kheir N;Harbarth S;Rodríguez-Baño J;Tacconelli E;Arieti F;Gladstone BP;de Kraker MEA;Naylor NR;Robotham JV; ;
{Journal}: Clin Microbiol Infect
{Volume}: 30
{Issue}: 0
{Year}: 2024 Mar 19
{Factor}: 13.31
{DOI}: 10.1016/j.cmi.2023.12.013
{Abstract}: <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.