title: Clinical Outcomes and Healthcare Utilization Related to Multidrug-Resistant Gram-Negative Infections in Community Hospitals.
abstract: OBJECTIVE To evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on mortality and healthcare resource utilization in community hospitals. DESIGN Two matched case-control analyses. SETTING Six community hospitals participating in the Duke Infection Control Outreach Network from January 1, 2010, through December 31, 2012. PARTICIPANTS Adult patients admitted to study hospitals during the study period. METHODS Patients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1) patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric, non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization, length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the effect of MDR status on each outcome measure. RESULTS No mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03 higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04-3.97, P=.04). There was no difference in hospital direct costs between patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02-$8,274.05, P<.001) and resulted in 3.40 extra hospital days (95% CI, 1.41-5.40, P<.001) than hospitalizations for control patients. CONCLUSIONS Our study provides novel data regarding the clinical and financial impact of MDR gram-negative bacterial infections in community hospitals. There was no difference in mortality between patients with MDR-GNR infections and patients with nonMDR-GNR infections or control patients. Infect Control Hosp Epidemiol 2016;1-8.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Duke UniversityMedical Center,Durham,North Carolina.
authors.forename: Kristen V
authors.initials: KV
authors.lastname: Dicks
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Duke UniversityMedical Center,Durham,North Carolina.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Duke UniversityMedical Center,Durham,North Carolina.
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Baker
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Duke UniversityMedical Center,Durham,North Carolina.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Duke UniversityMedical Center,Durham,North Carolina.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Lewis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003428:Cross Infection / Q000401:mortality*; D018432:Drug Resistance, Multiple; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000401:mortality*; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006764:Hospitals, Community; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology