dc.contributor.author |
Thaden, Joshua T |
|
dc.contributor.author |
Li, Yanhong |
|
dc.contributor.author |
Ruffin, Felicia |
|
dc.contributor.author |
Maskarinec, Stacey A |
|
dc.contributor.author |
Hill-Rorie, Jonathan M |
|
dc.contributor.author |
Wanda, Lisa C |
|
dc.contributor.author |
Reed, Shelby D |
|
dc.contributor.author |
Fowler, Vance G |
|
dc.coverage.spatial |
United States |
|
dc.date.accessioned |
2017-03-01T18:58:44Z |
|
dc.date.available |
2017-03-01T18:58:44Z |
|
dc.date.issued |
2016-12-19 |
|
dc.identifier |
https://www.ncbi.nlm.nih.gov/pubmed/27993852 |
|
dc.identifier |
AAC.01709-16 |
|
dc.identifier.uri |
https://hdl.handle.net/10161/13738 |
|
dc.description.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.
|
|
dc.language |
eng |
|
dc.publisher |
American Society for Microbiology |
|
dc.relation.ispartof |
Antimicrob Agents Chemother |
|
dc.relation.isversionof |
10.1128/AAC.01709-16 |
|
dc.title |
Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are
Primarily Due to Patients with Hospital-Acquired Infections.
|
|
dc.type |
Journal article |
|
duke.contributor.id |
Thaden, Joshua T|0564495 |
|
duke.contributor.id |
Maskarinec, Stacey A|0655923 |
|
duke.contributor.id |
Reed, Shelby D|0272070 |
|
duke.contributor.id |
Fowler, Vance G|0025542 |
|
pubs.author-url |
https://www.ncbi.nlm.nih.gov/pubmed/27993852 |
|
pubs.organisational-group |
Basic Science Departments |
|
pubs.organisational-group |
Clinical Science Departments |
|
pubs.organisational-group |
Duke |
|
pubs.organisational-group |
Duke Cancer Institute |
|
pubs.organisational-group |
Duke Clinical Research Institute |
|
pubs.organisational-group |
Institutes and Centers |
|
pubs.organisational-group |
Medicine |
|
pubs.organisational-group |
Medicine, General Internal Medicine |
|
pubs.organisational-group |
Medicine, Infectious Diseases |
|
pubs.organisational-group |
Molecular Genetics and Microbiology |
|
pubs.organisational-group |
School of Medicine |
|
pubs.organisational-group |
Staff |
|
pubs.publication-status |
Published online |
|
dc.identifier.eissn |
1098-6596 |
|
duke.contributor.orcid |
Thaden, Joshua T|0000-0002-3250-0697 |
|
duke.contributor.orcid |
Reed, Shelby D|0000-0002-7654-4464 |
|
duke.contributor.orcid |
Fowler, Vance G|0000-0002-8048-0897 |
|