Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship.
BACKGROUND
Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI).


METHODS
A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI.


RESULTS
In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from $18,588 to $29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4-12.7 days, and attributable mortality was 6.5%. The societal costs were $10.7-$15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort.


CONCLUSIONS
The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.
Roberts
Rebecca R
RR
Department of Emergency Medicin, John H Stroger Jr Hospital of Cook County, Chicago, Illinois 60612, USA.
Hota
Bala
B
Ahmad
Ibrar
I
Scott
R Douglas
RD
Foster
Susan D
SD
Abbasi
Fauzia
F
Schabowski
Shari
S
Kampe
Linda M
LM
Ciavarella
Ginevra G
GG
Supino
Mark
M
Naples
Jeremy
J
Cordell
Ralph
R
Levy
Stuart B
SB
Weinstein
Robert A
RA
D018806:APACHE; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D002641:Chicago; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy
D000900:Anti-Bacterial Agents