Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji

• DOI: 10.1016/j.jgar.2022.06.016
• Publication Date: 2022-06-20T16:47:31Z
• Authors: Michael J. Loftus; Tracey E.M.W. You...; Sue J. Lee; Shitanjni Wati; Gnei Z. Badoordeen; Luke V. Blakeway; Sally M.H. Byers; Allen C. Cheng; Ben S. Cooper; Hugh Cottingham; Adam W.J. Jenney; Jane Hawkey; Nenad Macesic; Ravi Naidu; Amitesh Prasad; Vinita Prasad; Litia Tudravu; Timoci Vakatawa; Elke van Gorp; Jessica A. Wisnie...; Eric Rafai; Anton Y. Peleg; Andrew J. Stewardson
• Keywords: Bloodstream infection

There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin (3GC-R) mortality excess length hospital stay in Fiji. conducted a prospective cohort study inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. used cause-specific Cox proportional hazards models estimate 3GC-R daily risk (hazard) in-hospital being discharged alive (competing risks), we multistate modelling stay. From July 2020 February 2021 identified 162 consecutive BSIs; was present 66 (40.7%). Crude for patients 3GC-susceptible BSIs 16.7% (16/96) 30.3% (20/66), respectively. not associated hazard rate (adjusted ratio [aHR] 1.13, 95% confidence interval [CI] 0.51–2.53) or (aHR 0.99, CI 0.65–1.50), whereas Charlson comorbidity index score 1.62, 1.36–1.93) Pitt bacteraemia 3.57, 1.31–9.71) were both an increased mortality. 2.6 days (95% 2.5–2.8). more common among hospital-associated infections, but genomics did identify clonal transmission. Patients Fiji had high rates 3GC-R, which