Cost of Gram-negative resistance*

Evans, Heather L.; Lefrak, Shayna; Lyman, Jason A.; Smith, Robert L.; Chong, Tae W.; McElearney, Shannon T.; Schulman, Andrew; Hughes, Michael G.; Raymond, Daniel P.; Pruett, Timothy L.; Sawyer, Robert G.

doi:10.1097/01.ccm.0000251496.61520.75

Cited by 111 publications

(108 citation statements)

References 35 publications

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“…It is particularly noteworthy that costs in infections from resistant microorganisms without mortality during the first 3 days are very high. One study from the United States assessed the costs of antibiotics used in sensitive and resistant gram-negative cases and reported high antibiotic costs in resistant microorganisms (27).…”

Section: Discussionmentioning

confidence: 99%

Cost analysis and evaluation of nosocomial infections in intensive care units

Kostakoğlu¹,

Saylan²,

Karataş³

et al. 2016

Turk J Med Sci

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Background/aim: The purpose of this study was to evaluate nosocomial infections occurring in our hospital intensive care units (ICUs) and the risk factors for these, and to determine the effect of these infections on mortality and cost. Materials and methods:This retrospective study was performed via infection control committee surveillance data, ICU records, and information processing data between 1 January and 31 December 2013 at the Kanuni Education and Research Hospital.Results: A total of 309 nosocomial infections were observed in 205 out of 566 patients. The density of nosocomial infections was 25.4 in 1000 patient days. Hospitalization was prolonged, and APACHE II and Charlson comorbidity scores were high in patients developing nosocomial infections (P < 0.001). Of the patients diagnosed with a nosocomial infection, 170 died. Infections were determined as the cause of death in 62 (36.5%) of the nonsurviving patients with a nosocomial infection. Acinetobacter baumannii was identified in 46 (74.2%) of the patients that died from nosocomial infections. The mean cost in patients developing a nosocomial infection was 15,229.30 Turkish lira (TL), compared to 9648.00 TL in patients without a nosocomial infection (P = 0.002). Conclusion:Regular infection control education sessions need to be held and the number of nurses needs to be increased in order to be able to reduce this high mortality, morbidity, and cost.

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Section: Discussionmentioning

confidence: 99%

Cost analysis and evaluation of nosocomial infections in intensive care units

Kostakoğlu¹,

Saylan²,

Karataş³

et al. 2016

Turk J Med Sci

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show abstract

“…12 The impact of multidrug resistant PA (MDRPA) on mortality and costs to the health service is illustrated by several studies. 7,13,14 Patients with MDRPA had significantly higher in-hospital mortality than those with more susceptible strains (67% vs. 23%; P=0.001). Reported mortality rates in adults with MDRPA range from 20% to 70%, depending on patient-and infectionrelated factors.…”

Section: Introductionmentioning

confidence: 99%

Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation

Caselli

Cesaro²,

Ziino

et al. 2010

Haematologica

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Pseudomonas aeruginosa is one leading gram-negative organism associated with nosocomial infections. Bacteremia is life-threatening in the immunocompromised host. Increasing frequency of multi-drug-resistant (MDRPA) strains is concerning. We started a retrospective survey in the pediatric hematology oncology Italian network. Between 2000 and 2008, 127 patients with Pseudomonas aeruginosa bacteremia were reported from 12 centers; 31.4% of isolates were MDRPA. Death within 30 days of a positive blood culture occurred in 19.6% (25/127) of total patients; in patients with MDRPA infection it occurred in 35.8% (14/39). In the multivariate analysis, only MDRPA had significant association with infection-related death. This is the largest series of Pseudomonas aeruginosa bacteremia cases from pediatric hematology oncology centers. Monitoring local bacterial isolates epidemiology is mandatory and will allow empiric antibiotic therapy to be tailored to reduce fatalities.

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“…Furthermore, because of these patterns of increased resistance, HCA-cSSSI patients, similar to other HCAI groups, may be at an increased risk of being treated with initially inappropriate antibiotic therapy. 7,10 Since in the setting of other types of infection inappropriate empiric treatment has been shown to be associated with increased mortality and costs, 7,[10][11][12][13][14][15] and since indirect evidence suggests a similar impact on healthcare utilization among cSSSI patients, 8 we hypothesized that among a cohort of patients hospitalized with a cSSSI, the initial empiric choice of therapy is independently associated with hospital length of stay (LOS). We performed a retrospective cohort study to address this question.…”

mentioning

confidence: 99%

Hospitalizations with healthcare‐associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomes

Zilberberg

Shorr

Micek

et al. 2010

Journal of Hospital Medicine

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OBJECTIVE:Inappropriate empiric therapy worsens outcomes in certain healthcare-associated infections (HCAI). We studied the association of inappropriate empiric therapy with outcomes in patients with HCA complicated skin and skin structure infections (cSSSI). DESIGN:A single-center retrospective cohort study. PATIENTS: Hospitalized with a culture-positive cSSSI. MEASUREMENTS: We defined HCA-cSSSI as having !1 of these risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, (4) transfer from a nursing home, and inappropriate treatment as no antimicrobial therapy active against the pathogen(s) within 24 hours of obtaining culture specimen. We performed descriptive and multivariate statistics to compute the impact of inappropriate empiric therapy on outcomes. Hospital length of stay (LOS) served as primary and mortality as secondary outcomes. RESULTS:Of the 717 patients with culture-positive cSSSI, 527 (73.5%) had HCAI, of whom 405 (76.9%) received appropriate treatment. A higher proportion of those receiving inappropriate than appropriate treatment had a decubitus ulcer (29.5% vs. 10.9%, P < 0.001), a device-associated infection (42.6% vs. 28.6%, P ¼ 0.004), or bacteremia (68.9% vs. 57.8%, P ¼ 0.028). The frequency of methicillin-resistant Staphylococcus aureus (MRSA) did not differ between the groups. The low overall unadjusted mortality rate did not vary based on initial treatment. In a multivariable analysis adjusting for potential confounders inappropriate therapy had an attributable increase in hospital LOS of 1.8 days (95% CI, 1.4-2.3).CONCLUSION: Similar to other populations with HCAI, HCA-cSSSI patients are likely to receive inappropriate empiric therapy for their infection. This early exposure is associated with a significant prolongation of the hospitalization by nearly 2 days.

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Cost of Gram-negative resistance*

Abstract: Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.

Cited by 111 publications

References 35 publications

Cost analysis and evaluation of nosocomial infections in intensive care units

Cost analysis and evaluation of nosocomial infections in intensive care units

Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation

Hospitalizations with healthcare‐associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomes

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