Document Detail


Costs of healthcare- and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms.
MedLine Citation:
PMID:  22700828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We compared 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.
METHODS: A retrospective analysis of an electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources was undertaken on 5699 inpatients who developed healthcare- or community-associated infections between 2006 and 2008 from 4 hospitals (1 community, 1 pediatric, 2 tertiary/quaternary care) in Manhattan. The main outcome measures were 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 infections, when compared with susceptible strains of the same organism, were associated with significantly higher charges ($15,626; confidence interval [CI], $4339-$26,913 and $25,573; CI, $9331-$41,816, respectively) and longer hospital stays for community-associated infections (3.3; CI, 1.5-5.4). Patients with resistant healthcare-associated infections also had a significantly higher death rate (0.04; CI, 0.01-0.08).
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.
Authors:
Matthew J Neidell; Bevin Cohen; Yoko Furuya; Jennifer Hill; Christie Y Jeon; Sherry Glied; Elaine L Larson
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-14
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  55     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-22     Completed Date:  2013-01-08     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  807-15     Citation Subset:  IM    
Affiliation:
Mailman School of Public Health, Columbia University, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Bacteremia / economics,  epidemiology,  microbiology,  mortality
Bacterial Infections / economics*,  epidemiology,  microbiology*,  mortality
Case-Control Studies
Community-Acquired Infections / economics*,  epidemiology,  microbiology*,  mortality
Cross Infection / economics*,  epidemiology,  microbiology*,  mortality
Databases, Factual
Drug Resistance, Bacterial*
Female
Health Care Costs
Hospital Charges / statistics & numerical data
Humans
Length of Stay / economics,  statistics & numerical data
Male
Middle Aged
New York City / epidemiology
Pneumonia, Bacterial / economics,  epidemiology,  microbiology,  mortality
Retrospective Studies
Survival Analysis
Urinary Tract Infections / economics,  epidemiology,  microbiology,  mortality
Grant Support
ID/Acronym/Agency:
5R01NR010822/NR/NINR NIH HHS; R01 NR010822/NR/NINR NIH HHS
Comments/Corrections

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