Clinical and economic impact of multidrug resistance in nosocomial Acinetobacter baumannii bacteremia.
OBJECTIVE
To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) Acinetobacter baumannii bacteremia.


METHODS
A retrospective, matched-cohort study.


METHODS
A tertiary care university teaching hospital.


METHODS
A matched case-control (1 : 1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR A. baumannii bacteremia and patients with non-MDR A. baumannii bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia.


RESULTS
Forty-six (95.8%) of 48 cases with MDR A. baumannii bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; P=.036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; P=.006), hospitalization cost (US$9,349 vs US$4,865; P=.001), and antibiotic therapy cost (US$2,257 vs US$1,610; P=.014). Thus, bacteremia due to MDR A. baumannii resulted in 13.4 days of additional hospitalization and US$3,758 of additional costs, compared with bacteremia due to non-MDR A. baumannii.


CONCLUSIONS
Patients with MDR A. baumannii bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR A. baumannii bacteremia.
Lee
Nan-Yao
NY
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan, Taiwan.
Lee
Hsin-Chun
HC
Ko
Nai-Ying
NY
Chang
Chia-Ming
CM
Shih
Hsin-I
HI
Wu
Chi-Jung
CJ
Ko
Wen-Chien
WC
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D017721:Hospital Costs; D017052:Hospital Mortality; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
D000900:Anti-Bacterial Agents