title: Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections.
abstract: BACKGROUND Our objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies. METHODS We identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections. RESULTS Our estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10-32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%-29.4%). With an incidence rate of 0.141 (95% CI, 0.136-0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509-13,625) in the United States. CONCLUSION The estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs. Infect Control Hosp Epidemiol 2016;1-7.
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: 3Department of Pharmacotherapy,University of Utah College of Pharmacy,Salt Lake City,Utah.
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.affiliation: 3Department of Pharmacotherapy,University of Utah College of Pharmacy,Salt Lake City,Utah.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Nelson
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Karim
authors.initials: K
authors.lastname: Khader
authors.affiliation: 5Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Hsiu-Yin
authors.initials: HY
authors.lastname: Chiang
authors.affiliation: 6Department of Epidemiology,University of Iowa College of Public Health,Iowa City,Iowa.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Chorazy
authors.affiliation: 5Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Amy
authors.initials: A
authors.lastname: Blevins
authors.affiliation: 5Department of Internal Medicine,University of Iowa Carver College of Medicine,Iowa City,Iowa.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Ward
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000150:Acinetobacter / Q000187:drug effects; D000151:Acinetobacter Infections / Q000188:drug therapy / Q000191:economics* / Q000401:mortality*; D040981:Acinetobacter baumannii; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics* / Q000382:microbiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D009010:Monte Carlo Method; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs