title: Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.
abstract: BACKGROUND
  We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.
  
  
  METHODS
  A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs.
  
  
  RESULTS
  Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively).
  
  
  CONCLUSIONS
  P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.
authors.affiliation: Health Services Evaluation and Clinical Epidemiology Department, Hospital del Mar-IMIM, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Morales
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Mercè
authors.initials: M
authors.lastname: Comas
authors.forename: Francesc
authors.initials: F
authors.lastname: Belvis
authors.forename: Marta
authors.initials: M
authors.lastname: Riu
authors.forename: Margarita
authors.initials: M
authors.lastname: Salvadó
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Maria Milagro
authors.initials: MM
authors.lastname: Montero
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017721:Hospital Costs / Q000639:trends*; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006784:Hospitals, Teaching; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000191:economics*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012189:Retrospective Studies; D013030:Spain
chemical_list: D000900:Anti-Bacterial Agents