Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are Primarily Due to Patients with Hospital-Acquired Infections.

Thaden, Joshua T

Li, Yanhong

Ruffin, Felicia

Maskarinec, Stacey A

Hill-Rorie, Jonathan M

Wanda, Lisa C

Reed, Shelby D

Fowler, Vance G

United States

2017-03-01T18:58:44Z

2017-03-01T18:58:44Z

2016-12-19

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.

https://www.ncbi.nlm.nih.gov/pubmed/27993852

AAC.01709-16

1098-6596

https://hdl.handle.net/10161/13738

eng

American Society for Microbiology

Antimicrob Agents Chemother

10.1128/AAC.01709-16

Increased Costs with Multidrug Resistant Gram Negative Bloodstream Infections Are Primarily Due to Patients with Hospital-Acquired Infections.

Journal article

Thaden, Joshua T|0000-0002-3250-0697

Ruffin, Felicia|0000-0003-2176-6462

Reed, Shelby D|0000-0002-7654-4464

Fowler, Vance G|0000-0002-8048-0897

https://www.ncbi.nlm.nih.gov/pubmed/27993852

Basic Science Departments

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, General Internal Medicine

Medicine, Infectious Diseases

Molecular Genetics and Microbiology

School of Medicine

Staff

Published online