Costs of healthcare-and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms

Matthew J. Neidell, Bevin Cohen, Yoko Furuya, Jennifer Hill, Christie Y. Jeon, Sherry Glied, Elaine L. Larson

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)807-815
Number of pages9
JournalClinical Infectious Diseases
Volume55
Issue number6
DOIs
StatePublished - Sep 2012

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Cross Infection
Length of Stay
Costs and Cost Analysis
Confidence Intervals
Hospital Charges
Infection
Mortality
Delivery of Health Care
Acinetobacter baumannii
Enterococcus faecium
Propensity Score
Enterococcus faecalis
Klebsiella pneumoniae
Tertiary Healthcare
Hospital Mortality
Urinary Tract Infections
Pseudomonas aeruginosa
Staphylococcus aureus
Motivation
Inpatients

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Costs of healthcare-and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. / Neidell, Matthew J.; Cohen, Bevin; Furuya, Yoko; Hill, Jennifer; Jeon, Christie Y.; Glied, Sherry; Larson, Elaine L.

In: Clinical Infectious Diseases, Vol. 55, No. 6, 09.2012, p. 807-815.

Research output: Contribution to journalArticle

Neidell, Matthew J. ; Cohen, Bevin ; Furuya, Yoko ; Hill, Jennifer ; Jeon, Christie Y. ; Glied, Sherry ; Larson, Elaine L. / Costs of healthcare-and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 6. pp. 807-815.
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