Costs of Healthcare- and Community-Associated Infections With Antimicrobial-Resistant versus Susceptible Organisms.
Clin Infect Dis. 2012 Jun 14;
Authors: Neidell MJ, Cohen B, Furuya Y, Hill J, Jeon CY, Glied S, Larson EL
Context.?Despite general agreement that antimicrobial resistance is associated with worse patient outcomes and higher costs, more rigorous methods are needed to more fully understand this relationship.Objective.?To compare differences in the hospital charges, length of hospital stay and mortality between patients with healthcare- and community-associated bloodstream infections, urinary tract infections and pneumonia due to antimicrobial resistant versus susceptible bacterial strains.Design.?Retrospective analysis of electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources.Setting.?Four hospitals (community, pediatric, two tertiary/quaternary care) in northern Manhattan.Patients.?5,699 in-patients who developed healthcare- or community-associated infection between 2006 and 2008.Main Outcome Measure(s).?Hospital charges, length of stay, and mortality among patients with antimicrobial-resistant and susceptible infections caused by Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii.Results.?Controlling for multiple confounders using linear regression and nearest neighbor matching based on propensity score estimates, resistant healthcare- and community-associated infection when compared with susceptible strains of the same organism were associated with significantly higher charges ($15,626 [4,339-26,913] and $25,573 [9,331-41,816], respectively) and longer hospital stays for community-associated infections (3.3 [1.5-5,4]). Those with resistant healthcare-associated also had a significantly higher death rate (0.04 [.01-.08]). Conclusions: With careful matching of patients infected with the same organism, antimicrobial resistance was associated with higher charges, length of stay and death rates. The difference in estimates after accounting for censoring for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial resistant infections.
PMID: 22700828 [PubMed - as supplied by publisher]