title: Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship.
abstract: 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.
authors.affiliation: Department of Emergency Medicin, John H Stroger Jr Hospital of Cook County, Chicago, Illinois 60612, USA.
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Roberts
authors.forename: Bala
authors.initials: B
authors.lastname: Hota
authors.forename: Ibrar
authors.initials: I
authors.lastname: Ahmad
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Scott
authors.forename: Susan D
authors.initials: SD
authors.lastname: Foster
authors.forename: Fauzia
authors.initials: F
authors.lastname: Abbasi
authors.forename: Shari
authors.initials: S
authors.lastname: Schabowski
authors.forename: Linda M
authors.initials: LM
authors.lastname: Kampe
authors.forename: Ginevra G
authors.initials: GG
authors.lastname: Ciavarella
authors.forename: Mark
authors.initials: M
authors.lastname: Supino
authors.forename: Jeremy
authors.initials: J
authors.lastname: Naples
authors.forename: Ralph
authors.initials: R
authors.lastname: Cordell
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Levy
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents