1796. Economic Impact of Carbapenameses-Producing Enterobacteriaceae Causing Bloodstream Infections in Latin America
Session: Poster Abstract Session: Resistant Gram-Negative Infections: CRE Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
  • 2015-10-02 Pfizer Economic (final).pdf (141.3 kB)
  • Background: Infections caused by carbapenemases-producing Enterobacteriaceae(CPE) have additional attributable cost especially because of the increased use of broad-spectrum antibiotics (BSA) and prolonged hospitalization. However, available data in Latin America is limited. The aim of this study was to determine the economic impact of CPE causing Bloodstream Infections (BSIs) in Latin America, in terms of Length of Stay (LOS) and costs associated with the use of BSA. 

    Methods: Between Jul 2013 and Nov 2014, we conducted a multicenter cohort study in 13 tertiary healthcare settings from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Peru and Venezuela).  Patients with the first episode of bacteremia and at least one positive blood culture for Enterobacteriaceae were included and followed until discharge or death. We compared differences in costs of BSA and LOS between patients with CPE causing BSIs versus non-CPE. The costs associated with the use of BSA were calculated according to the minimum sale price authorized for each country and costs of LOS were calculated according to the price of a bed-day by type of room; values were adjusted for annual inflation reference and converted to US dollars with 2013 exchange rate in 2013. Statistical differences were analyzed using the Wilcoxon Mann-Whitney test.

    Results: A total of 253 patients were included and CPE isolates were identified in 54 patients. Klebsiella pneumoniae (42.3%), Escherichia coli (38.8%) and Enterobacter spp. (5.9%) were the most common CPE isolated from BSIs. The most frequently BSA prescribed were meropenem (59.3%), polymyxin/colistin (32.8%) and vancomycin (25.7%). The use of BSA was higher in the CPE compared to non – CPE group (median values: 3 vs. 2 antibiotics, P =0.003). Costs associated to BSA attributable to CPE causing BSIs were $ 2,186 USD and $ 916 USD in non-CPE BSIs (p=0.002). The median LOS in the CPE group was 19 days compared to 16 days in the non-CPE group (p=0.685), and the cost per hospital stay was greater in the CPE group vs non-CPE group (medians: $ 7,258 USD vs. $2,667 USD, p<0.001).

    Conclusion: This is the first report in Latin America that demonstrates higher attributable costs associated with BSIs caused by CPE due to the use of BSA and increased LOS. Bigger efforts should be done by the hospitals and government to control the dissemination of CPE

    Cristhian Hernandez, Bsc1, Gabriel Motoa, MD1, Christian Pallares, MD, MSc1, Juan Sebastian Muñoz, MD1, Kevin Escandón-Vargas, MD1, Carlos Alvarez, MD, FIDSA2, Fernando Rosso, MD, MSC3, Carlos Seas, MD, FIDSA4, Jose Hidalgo, MD5, Carlos Mejia, MD6, Jeannnete Zurita, MD7, Manuel Guzman-Blanco, MD8, Carlos Luna, MD9, Eduardo Rodríguez, MD10, Manuel CortesÍa, M. D11, Lorena Matta, M.D12 and Maria Virginia Villegas, MD, MSc, FIDSA1, (1)Bacterial Resistance and Hospital Epidemiology, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia, (2)Pontificia Universidad Javeriana, Bogota, Colombia, (3)Clinical Research Center, Fundacion Valle del Lili, Cali, Colombia, (4)Hospital Cayetano Heredia, Lima, Peru, (5)Guillermo Almenara Hospital, Lima, Peru, (6)Department of Internal Medicine, Hospital Roosevelt, Guatemala, Guatemala, (7)Hospital Vozandes, Quito, Ecuador, (8)Hospital Vargas de Caracas, Caracas, Venezuela, (9)Pulmonary Division, Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina, (10)Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico, (11)Hospital de Clínicas Caracas, CARACAS, Venezuela, (12)Internal Medicine, Hospital Universitario del Valle- Evaristo García, E. S. E, CALI, Colombia


    C. Hernandez, merck sharp & dohme: Consultant , Consulting fee

    G. Motoa, None

    C. Pallares, merck sharp & dohme: Consultant , Consulting fee

    J. S. Muñoz, None

    K. Escandón-Vargas, None

    C. Alvarez, Pfizer: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
    Merck Sharp and Dohme: Speaker's Bureau , Speaker honorarium
    Glaxo Smith Kline Beechan: Speaker's Bureau , Speaker honorarium
    Astra Zeneca: Speaker's Bureau , Speaker honorarium

    F. Rosso, None

    C. Seas, None

    J. Hidalgo, None

    C. Mejia, MSD: Investigator , Research grant

    J. Zurita, None

    M. Guzman-Blanco, Pfizer: Board Member and Investigator , Consulting fee and Grant recipient
    Astra Zeneca: Grant Investigator , Grant recipient
    Merck Sharp and Dohme: Board Member and Grant Investigator , Consulting fee and Research grant
    Beckton Dickinson: Board Member , Consulting fee

    C. Luna, None

    E. Rodríguez, None

    M. CortesÍa, None

    L. Matta, None

    M. V. Villegas, merck sharp & dohme: Consultant , Consulting fee and Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.