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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Published Version (Please cite this version)

10.1128/AAC.01709-16

Publication Info

Thaden, Joshua T, Yanhong Li, Felicia Ruffin, Stacey A Maskarinec, Jonathan M Hill-Rorie, Lisa C Wanda, Shelby D Reed, Vance G Fowler, et al. (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.

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Scholars@Duke

Thaden

Joshua Thomas Thaden

Assistant Professor of Medicine
Fowler

Vance Garrison Fowler

Florence McAlister Distinguished Professor of Medicine

Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia
Antibacterial Resistance
Pathogenesis of Bacterial Infections
Tropical medicine/International Health


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