title: The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study.
abstract: BACKGROUND
  Infections due to multi-drug resistant gram negative bacilli (RGNB) in critically ill patients have been reported to be associated with increased morbidity and costs and only a few studies have been done in Asia. We examined the financial impact of nosocomial RGNB infections among critically ill patients in Singapore.
  
  
  METHODS
  A nested case control study was done for patients at medical and surgical ICUs of a tertiary university hospital (August 2007-December 2011) matched by propensity scores. Two groups of propensity-matched controls were selected for each case patient with nosocomial drug resistant gram negative infection: at-risk patients with no gram negative infection or colonization (Control A) and patients with ICU acquired susceptible gram negative infection (SGNB) (Control B). The costs of the hospital stay, laboratory tests and antibiotics prescribed as well as length of stay were compared using the Wilcoxon matched-pairs signed rank test.
  
  
  RESULTS
  Of the 1539 patients included in the analysis, 76 and 65 patients had ICU acquired RGNB and SGNB infection respectively. The median(range) total hospital bill per day for patients with RGNB infection was 1.5 times higher than at-risk patients without GNB infection [Singapore dollars 2637.8 (458.7-20610.3) vs. 1757.4 (179.9-6107.4), p0.0001]. The same trend was observed when compared with SGNB infected patients. The median costs per day of antibiotics and laboratory investigations were also found to be significantly higher for patients with RGNB infection. The length of stay post infection was not found to be different between those infected with RGNB and SGNB.
  
  
  CONCLUSIONS
  The economic burden of RGNB infections to the patients and the hospital is considerable. Efforts need to be taken to prevent their occurrence by cost effective infection control practices.
authors: Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597 Singapore.
authors: Anupama
authors: A
authors: Vasudevan
authors: Steward Carney Hospital, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02110 USA.
authors: Babar Irfan
authors: BI
authors: Memon
authors: Division of Respiratory and Critical Care Medicine, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore.
authors: Amartya
authors: A
authors: Mukhopadhyay
authors: Department of Statistics and Applied Probability, National University of Singapore, Faculty of Science, 6 Science Drive 2, Singapore, 119077 Singapore.
authors: Jialiang
authors: J
authors: Li
authors: Division of Infectious Diseases, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore.
authors: Paul Ananth
authors: PA
authors: Tambyah
keywords: Costs; Critically ill patient; ICU; Resistant gram negative infection; Sensitive gram negative infection
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