title: Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections.
abstract: The clinical and economic impacts of bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria are incompletely understood. From 2009 to 2015, all adult inpatients with Gram-negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram-negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram-negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio, 1.60; 95% confidence interval [CI], 1.19 to 2.16;P= 0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] versus 0.2% [1/599];P= 0.02) and longer hospital stay (median, 10.0 versus 8.0 days;P= 0.0005). Unadjusted rates of in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P= 0.12). Unadjusted mean costs were 1.62 times higher in MDR than in non-MDR BSI ($59,266 versus $36,452;P= 0.003). This finding persisted after adjustment for patient factors and appropriate empirical antibiotic therapy (means ratio, 1.18; 95% CI, 1.03 to 1.36;P= 0.01). Adjusted analysis of patient subpopulations revealed that the increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio, 1.41; 95% CI, 1.10 to 1.82;P= 0.008). MDR Gram-negative BSI are associated with recurrent BSI, longer hospital stays, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost.
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Thaden
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Ruffin
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
authors.forename: Stacey A
authors.initials: SA
authors.lastname: Maskarinec
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Hill-Rorie
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Wanda
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Division of Infectious Diseases, Duke University, Durham, North Carolina, USA Vance.Fowler@duke.edu.|Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram negative; bloodstream infection; cost