{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:52:13Z","timestamp":1791215533817,"version":"4.1.0"},"reference-count":40,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":700,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:sec id=\"S0195941700032203_abs1\"><jats:title>Objective.<\/jats:title><jats:p>To obtain an unbiased estimate of the excess hospital length of stay (LOS) and cost attributable to extended-spectrum \u03b2-lactamase (ESBL) positivity in bloodstream infections (BSIs) due to Enterobacteriaceae.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs2\"><jats:title>Design.<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs3\"><jats:title>Setting.<\/jats:title><jats:p>A 2,200-bed academic medical center in Geneva, Switzerland.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs4\"><jats:title>Patients.<\/jats:title><jats:p>Patients admitted during 2009.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs5\"><jats:title>Methods.<\/jats:title><jats:p>We used multistate modeling and Cox proportional hazards models to determine the excess LOS and adjusted end-of-LOS hazard ratio (HR) for ESBL-positive and ESBL-negative BSI. We estimated economic burden as the product of excess LOS and average bed-day cost. Patient-level accounting data provided a complementary analysis of economic burden. A predictive model was fitted to national surveillance data.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs6\"><jats:title>Results.<\/jats:title><jats:p>Thirty ESBL-positive and 96 ESBL-negative BSI cases were included. The excess LOS attributable to ESBL-positive and ESBL-negative BSI was 9.4 (95% confidence interval [CI], 0.4\u201318.4) and 2.6 (95% CI, 0.7\u20135.9) days, respectively. ESBL positivity was therefore associated with 6.8 excess days and CHF 9,473 per BSI. The adjusted end-of-LOS HRs for ESBL-positive and ESBL-negative BSI were 0.62 (95% CI, 0.43\u20130.89) and 0.90 (95% CI, 0.74\u20131.10), respectively. After reimbursement, the average financial loss per acute care episode in ESBL-positive BSI, ESBL-negative BSI, and control cohorts was CHF 48,674, 48,131, and 13,532, respectively. Our predictive model estimated that the nationwide cost of third-generation cephalosporin resistance would increase from CHF 2,084,000 in 2010 to CHF 3,526,000 in 2015.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700032203_abs7\"><jats:title>Conclusions.<\/jats:title><jats:p>This is the first hospital-wide analysis of excess LOS attributable to ESBL positivity determined using multistate modeling to avoid time-dependent bias. These results may inform health-economic evaluations of interventions targeting ESBL control.<\/jats:p><\/jats:sec>","DOI":"10.1086\/669086","type":"journal-article","created":{"date-parts":[[2012,12,18]],"date-time":"2012-12-18T16:00:38Z","timestamp":1355846438000},"page":"133-143","source":"Crossref","is-referenced-by-count":53,"title":["Burden of Bloodstream Infection Caused by Extended-Spectrum \u03b2-Lactamase\u2013Producing Enterobacteriaceae Determined Using Multistate Modeling at a Swiss University Hospital and a Nationwide Predictive Model"],"prefix":"10.1017","volume":"34","author":[{"given":"Andrew","family":"Stewardson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Fankhauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia De","family":"Augelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rohner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Safran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Schrenzel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Pittet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Harbarth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700032203_ref038","doi-asserted-by":"publisher","DOI":"10.1086\/319757"},{"key":"S0195941700032203_ref033","doi-asserted-by":"publisher","DOI":"10.4161\/viru.3.1.18382"},{"key":"S0195941700032203_ref025","doi-asserted-by":"publisher","DOI":"10.1086\/502349"},{"key":"S0195941700032203_ref024","unstructured":"H\u00f4pitaux universitaires de Gen\u00e8ve. 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