Different Effects of Antibiotics on Klebsiella pneumoniae and Escherichia coli Resistance Induced by Antibiotics: A Retrospective Study from China.

Objective: The main objective was to assess the correlation between antibiotic use and carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Escherichia coli (CREC) induction by antibiotics. Materials and Methods: A retrospective cohort study was conducted from January 2017 to December 2020. This study included patients with K. pneumoniae and E. coli. Kaplan-Meier analysis and Cox proportional hazard model were used to estimate the hazard of carbapenem-resistant Enterobacterales (CRE), whereas restricted cubic spline regression was used to visualize the hazard of CRE by antibiotics at different doses. Results: Two thousand fifty-six K. pneumoniae patients and 3,243 E. coli patients were included. After Cox proportional hazard model analysis, carbapenems or 1st-cephalospoins or penicillin monotherapy, male and ICU admission were associated with CRKP. CREC was associated with quinolone monotherapy. Time-to-event analysis indicated that carbapenem, ß-lactamase inhibitor mixtures, and quinolones were associated with higher 30-day CRKP hazards than other antibiotics (χ2 = 33.670, p < 0.001). Further restricted cubic spline regression analysis found that the hazard of CRKP induction decreased with the increased dose of ß-lactamase inhibitor mixtures, but there was no significant change in the hazard ratio of CRKP induction with the increased dose of quinolones. Moreover, there was an obvious characteristic of "parabolic curve" for the hazard of CREC induction due to ß-lactamase inhibitor mixtures, and the hazard value gradually increased with the dose, reached the maximum at 24 g, and finally gradually decreased from 26 g. Conclusions: Rational use of antibiotics should be implemented and antimicrobial stewardship policies should be adjusted according to the characteristics of each hospital.

A multi-center nested case-control study on hospitalization costs and length of stay due to healthcare-associated infection.

Background: In 2018, the Chinese government demanded nationwide implementation of medical insurance payment methods based on Single-Disease Payment (SDP), but during the operation process the medical insurance system did not fully consider the extra economic burden caused by healthcare-associated infection (HAI). HAIs can prolong the length of stay and increase the hospitalization costs, but only a few studies have been conducted in Sichuan province, China. We evaluated the hospitalization costs and length of stay due to HAI in Sichuan province based on the prevalence survey, and provided data reference for China's medical insurance reform. Methods: In the hospitals surveyed on the prevalence of HAI, a multi-center nested case-control study was performed by a paired method. The study period was from 6 September 2016 to 30 November 2016. Binary outcomes were tested using χ2 test, continuous outcomes were tested using Wilcoxon matched-pairs signed rank test, intra-group comparisons were tested using multiple linear regression analysis. Results: A total of 225 pairs/450 patients were selected in 51 hospitals, and 170 pairs/350 patients were successfully matched. The case fatality rate was 5.14% for the HAIs patients and 3.43% for non-HAs patients, there was no significant difference (χ2 = 0.627, P = 0.429); the median length of stay in patients with HAIs was 21 days, longer than that of patients with non-HAI 16 days, the median of the difference between matched-pairs was 5 days, the difference was statistically significant (Z = 4.896, P = 0.000). The median hospitalization costs of patients with HAI were €1732.83, higher than that of patients with non-HAI €1095.29, the median of the difference between matched-pairs were €431.34, the difference was statistically significant (Z = 6.413, P = 0.000). Multiple linear regression results showed that HAIs at different sites have caused different economic burdens, but in different economic regions, the difference was not statistically significant. Conclusions: In Sichuan, the hospitalization costs and length of stay caused by HAI should be given special attention in the current medical insurance reform. The proportion and scope of medical payment for patients with HAI at different sites should be different. Efforts need to be taken to incentivize reduction of HAI rates which will reduce hospitalization costs and length of stay.