Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are Primarily Due to Patients with Hospital-Acquired Infections.
Abstract
The clinical and economic impact of bloodstream infections (BSI) due to multidrug
resistant (MDR) Gram negative bacteria is incompletely understood. From 2009-2015,
all adult inpatients with Gram negative BSI at our institution were prospectively
enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical
outcomes and inpatient costs associated with the MDR phenotype were identified. Among
891 unique patients with Gram negative BSI, 292 (33%) were infected with MDR bacteria.
In an adjusted analysis, only history of Gram negative infection was associated with
MDR BSI versus non-MDR BSI (odds ratio 1.60; 95% confidence interval [CI] 1.19-2.16;
P=0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] vs 0.2%
[1/599]; P=0.02) and longer hospital length of stay (median 10.0 vs.8.0 days; P=0.0005).
Unadjusted in-hospital mortality did not significantly differ between MDR (26.4% [77/292])
and non-MDR (21.7% [130/599]) groups (P=0.12). Unadjusted mean costs were 1.62 times
higher in MDR versus non-MDR BSI ($59,266 vs. $36,452; P=0.003). This finding persisted
after adjustment for patient factors and appropriate empiric antibiotic therapy (means
ratio 1.18; 95% CI 1.03-1.36; P=0.01). Adjusted analysis of patient sub-populations
revealed that increased cost of MDR BSI occurred primarily among patients with hospital-acquired
infections (MDR means ratio 1.41, 95% CI 1.10-1.82, P=0.008). MDR Gram negative BSI
are associated with recurrent BSI, longer hospital length of stay, and increased mean
inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account
for the increased cost.
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https://hdl.handle.net/10161/13738Published Version (Please cite this version)
10.1128/AAC.01709-16Publication Info
Thaden, Joshua T; Li, Yanhong; Ruffin, Felicia; Maskarinec, Stacey A; Hill-Rorie,
Jonathan M; Wanda, Lisa C; ... Fowler, Vance G (2016). Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are
Primarily Due to Patients with Hospital-Acquired Infections. Antimicrob Agents Chemother. 10.1128/AAC.01709-16. Retrieved from https://hdl.handle.net/10161/13738.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Vance Garrison Fowler Jr.
Florence McAlister Distinguished Professor of Medicine
Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia Antibacterial
ResistancePathogenesis of Bacterial Infections Tropical medicine/International Health
Stacey Ann Maskarinec
Assistant Professor of Medicine
Shelby Derene Reed
Professor in Population Health Sciences
Shelby D. Reed, PhD, is Professor in the Departments of Population Health Sciences
and Medicine at Duke University’s School of Medicine. She is the director of the
Center for Informing Health Decisions and Therapeutic Area leader for Population Health
Sciences at the Duke Clinical Research Institute (DCRI). She also is core faculty
at the Duke-Margolis Center for Health Policy. Dr. Reed has over 20 years of experience
leading multidisciplinary health outcomes research studie
Felicia Ruffin
Research Program Leader, Tier 1
Joshua Thomas Thaden
Assistant Professor of Medicine
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