title: The excess financial burden of multidrug resistance in severe gram-negative infections in Singaporean hospitals.
abstract: BACKGROUND
  Multidrug-resistant (MDR) Gram-negative healthcare-associated infections are prevalent in Singaporean hospitals. An accurate assessment of the socioeconomic impact of these infections is necessary in order to facilitate appropriate resource allocation, and to judge the costeffectiveness of targeted interventions.
  
  
  METHODS
  A retrospective cohort study involving inpatients with healthcare-associated Gram-negative bacteraemia at 2 large Singaporean hospitals was conducted to determine the hospitalisation costs attributed to multidrug resistance, and to elucidate factors affecting the financial impact of these infections. Data were obtained from hospital administrative, clinical and financial records, and analysed using a multivariate linear regression model.
  
  
  RESULTS
  There were 525 survivors of healthcare-associated Gram-negative bacteraemia in the study cohort, with 224 MDR cases. MDR bacteraemia, concomitant skin and soft tissue infection, higher APACHE II score, ICU stay, and appropriate definitive antibiotic therapy were independently associated with higher total hospitalisation costs, whereas higher Charlson comorbidity index and concomitant urinary tract infection were associated with lower costs. The excess hospitalisation costs attributed to MDR infection was $8638.58. In the study cohort, on average, 62.3% of the excess cost attributed to MDR infection was paid for by government subvention.
  
  
  CONCLUSIONS
  Multidrug resistance in healthcare-associated Gram-negative bacteraemia is associated with higher financial costs--a significant proportion of which are subsidised by public funding in the form of governmental subvention. More active interventions aimed at controlling antimicrobial resistance are warranted, and the results of our study also provide possible benchmarks against which the cost-effectiveness of such interventions can be assessed.
authors: Department of Medicine, National University Health System, Singapore.
authors: Esther
authors: E
authors: Ng
authors: Arul
authors: A
authors: Earnest
authors: David C
authors: DC
authors: Lye
authors: Moi Lin
authors: ML
authors: Ling
authors: Ying
authors: Y
authors: Ding
authors: Li Yang
authors: LY
authors: Hsu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore
chemical_list: D000900:Anti-Bacterial Agents