TY - JOUR
T1 - Costs of healthcare-and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms
AU - Neidell, Matthew J.
AU - Cohen, Bevin
AU - Furuya, Yoko
AU - Hill, Jennifer
AU - Jeon, Christie Y.
AU - Glied, Sherry
AU - Larson, Elaine L.
N1 - Funding Information:
Financial support. This work was supported by the National Institute of Nursing Research (5R01NR010822). Potential conflicts of interest. All authors: No reported conflicts.
PY - 2012/9
Y1 - 2012/9
N2 - Objective.We compared differences in the hospital charges, length of hospital stay, and mortality between patients with healthcare-and community-associated bloodstream infections, urinary tract infections, and pneumonia due to antimicrobial-resistant versus-susceptible bacterial strains.Methods.A retrospective analysis of an electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources was undertaken on 5699 inpatients who developed healthcare-or community-associated infections between 2006 and 2008 from 4 hospitals (1 community, 1 pediatric, 2 tertiary/quaternary care) in Manhattan. The main outcome measures were hospital charges, length of stay, and mortality among patients with antimicrobial-resistant and-susceptible infections caused by Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii.Results. Controlling for multiple confounders using linear regression and nearest neighbor matching based on propensity score estimates, resistant healthcare-and community-associated infections, when compared with susceptible strains of the same organism, were associated with significantly higher charges ($15 626; confidence interval [CI], $4339-$26 913 and $25 573; CI, $9331-$41 816, respectively) and longer hospital stays for community-associated infections (3.3; CI, 1.5-5.4). Patients with resistant healthcare-associated infections also had a significantly higher death rate (0.04; CI, 0.01-0.08).Conclusions.With careful matching of patients infected with the same organism, antimicrobial resistance was associated with higher charges, length of stay, and death rates. The difference in estimates after accounting for censoring for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial resistant infections.
AB - Objective.We compared differences in the hospital charges, length of hospital stay, and mortality between patients with healthcare-and community-associated bloodstream infections, urinary tract infections, and pneumonia due to antimicrobial-resistant versus-susceptible bacterial strains.Methods.A retrospective analysis of an electronic database compiled from laboratory, pharmacy, surgery, financial, and patient location and device utilization sources was undertaken on 5699 inpatients who developed healthcare-or community-associated infections between 2006 and 2008 from 4 hospitals (1 community, 1 pediatric, 2 tertiary/quaternary care) in Manhattan. The main outcome measures were hospital charges, length of stay, and mortality among patients with antimicrobial-resistant and-susceptible infections caused by Staphylococcus aureus, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii.Results. Controlling for multiple confounders using linear regression and nearest neighbor matching based on propensity score estimates, resistant healthcare-and community-associated infections, when compared with susceptible strains of the same organism, were associated with significantly higher charges ($15 626; confidence interval [CI], $4339-$26 913 and $25 573; CI, $9331-$41 816, respectively) and longer hospital stays for community-associated infections (3.3; CI, 1.5-5.4). Patients with resistant healthcare-associated infections also had a significantly higher death rate (0.04; CI, 0.01-0.08).Conclusions.With careful matching of patients infected with the same organism, antimicrobial resistance was associated with higher charges, length of stay, and death rates. The difference in estimates after accounting for censoring for death highlight divergent social and hospital incentives in reducing patient risk for antimicrobial resistant infections.
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U2 - 10.1093/cid/cis552
DO - 10.1093/cid/cis552
M3 - Article
C2 - 22700828
AN - SCOPUS:84865460977
SN - 1058-4838
VL - 55
SP - 807
EP - 815
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -