Hospital Cost Components and Predictors in Escherichia coli Bacteremia

Background/Objectives:Escherichia coli bacteremia is a major cause of morbidity, mortality, and healthcare expenditure. The increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) complicates management and resource utilization. This study aimed to identify clinical predictors of higher hospital costs in E. coli bacteremia. Methods: We conducted a cross-sectional study of hospitalized patients with E. coli bacteremia in Surabaya, Indonesia (2022-2024). Hospital costs were categorized into bed costs, diagnostic costs, pharmacy costs, antibiotic costs, total costs, and daily costs. Costs were compared between ESBL and non-ESBL cases. Predictors of higher hospital costs were analyzed using generalized linear models with a Gamma distribution and log-link. Results: Among 209 patients, 131 (62.7%) had ESBL-producing E. coli. ESBL E. coli bacteremia was associated with significantly higher bed, diagnostic, pharmacy, total, and daily hospital costs than non-ESBL cases, while antibiotic costs were similar. ESBL E. coli bacteremia was associated with higher diagnostic and daily costs. High-care/ICU stay was the strongest predictor of increased costs. Pneumonia and infection source influenced cost components. Longer hospitalization increased total cost but reduced daily cost. Conclusions: Hospital costs in Escherichia coli bacteremia are driven by antimicrobial resistance, disease severity, and healthcare utilization. Targeted strategies such as antimicrobial stewardship and optimized critical care use are essential to reduce the economic burden.