In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital

Abstract

BackgroundAntibiotic resistance is a challenge in the management of infectious diseases and can cause substantial cost. Even without the onset of infection, measures must be taken, as patients colonized with multi-drug resistant (MDR) pathogens may transmit the pathogen. We aim to quantify the cost of community-acquired MDR colonizations using routine data from a German teaching hospital.MethodsAll 2006 cases of documented MDR colonization at hospital admission recorded from 2011 to 2014 are matched to 7917 unexposed controls with the same primary diagnosis. Cases with an onset MDR infection are excluded from the analysis. Routine data on costs per case is analysed for three groups of MDR bacteria: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and multidrug-resistant gram-negative bacteria (MDR-GN). Multivariate analyses are conducted to adjust for potential confounders.ResultsAfter controlling for main diagnosis group, age, sex, and Charlson Comorbidity Index, MDR colonization is associated with substantial additional costs from the healthcare perspective (€1480.9, 95%CI €1286.4–€1675.5). Heterogeneity between pathogens remains. Colonization with MDR-GN leads to the largest cost increase (€1966.0, 95%CI €1634.6–€2297.4), followed by MRSA with €1651.3 (95%CI €1279.1–€2023.6), and VRE with €879.2 (95%CI €604.1–€1154.2). At the same time, MDR-GN is associated with additional reimbursements of €887.8 (95%CI €722.1–€1053.6), i.e. costs associated with MDR-colonization exceed reimbursement.ConclusionsEven without the onset of invasive infection, documented MDR-colonization at hospital admission is associated with increased hospital costs, which are not fully covered within the German DRG-based hospital payment system.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3549-0) contains supplementary material, which is available to authorized users.

Economic burden of antibiotic resistance in ESKAPE organisms: a systematic review

“…Compared with inpatients without infection, those with VRE were associated with 1.76 times higher ICU cost [71], and VRE BSI cases were associated with 2.66 times [72] higher total hospital charge and 5.14 times higher total hospital cost [58]. We also found that VRE colonized inpatients led to a significant cost increase of $1167 than those without colonization after controlling for variables [57] (Table 2 and Additional file 3: Table S2 and S8).…”

“…aureusMRSAWithout infectionTotal hospital chargeMedian (IQR)4911(2360–8387)2486(917–4350)2426(1444–4037)1.98< 0.05Fu et al [56]S. aureusMRSAWithout infectionTotal hospital costMedian (Q)15,763(160950)2185(43820)13,578(117130)7.210.0010Engler Husch et al [57]S. aureusMRSAWithout colonizaitonExcess total hospital costMean (95% CI)2193(1699–2688)< 0.01 MRSA methicillin resistant S. aureus , MSSA methicillin susceptible S. aureus , ICU intensive care unit, IQR interquartile range, Q quartile, USD the United States Dollars, SD standard deviation, CI confidence interval…”

“…Nevertheless, it is showed that there were no differences in total hospital cost or charge among BSI [26, 33, 36], breast abscess [34], skin and soft tissue infection [31, 32, 34, 72], and pneumonia [27–30] between the two groups. There was an additional median total hospital charge of $ 56,900 [45] and mean total hospital cost of $ 2193 [57] for MRSA colonization than that for MSSA colonization and those without colonization, respectively.…”

Nonclinical Pharmacokinetics, Protein Binding, and Elimination of KBP-7072, an Aminomethylcycline Antibiotic, in Animal Models

“…2 The rise in the incidence of infections caused by multidrug resistant (MDR) bacteria poses a significant problem for patients with serious, potentially life-threatening infections because of few available and effective treatment options. 8,9 The increased rate of resistance is associated with higher healthcare costs [10][11][12] and increased morbidity and mortality. 10,11 Bacterial resistance and potential side effects with some antibiotics, together with the substantial morbidity and mortality associated with resistant bacteria highlight the need for new antibiotics to treat common infections.…”

The Knowledge, Attitudes, and Practices of Community Pharmacists in their Approach to Antibiotic Use: A Nationwide Survey in Italy

“…Indeed, the threat of antibiotic resistance is increasing globally, and this has caused many infectious diseases to become untreatable, with considerable increases in treatment complexity, side effects, disability, and mortality [1,2]. Moreover, it is well established that antibiotic-resistant infectious diseases lead to an increase of healthcare costs for hospitalizations, additional diagnostic investigations, and treatments [3][4][5][6]. The prevention of antibiotic-resistant bacteria's development and diffusion is a worldwide public health priority and requires a complex approach that includes the participation of healthcare professionals, patients, the agricultural sector, and policy makers.…”