Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

Abstract

BackgroundWe aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.MethodsA retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs.ResultsCost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively).ConclusionsP. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

Molecular epidemiological survey of the quinolone- and carbapenem-resistant genotype and its association with the type III secretion system in Pseudomonas aeruginosa

“…Bacteraemia caused by MDR P. aeruginosa is a serious infection and is usually hospital acquired, occurring in patients with severe underlying diseases and raising the mortality rate (Morales et al, 2012; Suárez et al, 2010;Voor In't Holt et al, 2014) as a result of inappropriate antimicrobial therapy (Kang et al, 2005; Lodise et al, 2007). VAP is the most important infection in the ICU associated with significant increases in mortality, cost and length of hospital stay (Bassi et al, 2010;Davis, 2006;Park, 2005) and is responsible for about 6-52 % of ICU infections (Davis, 2006).…”

“…In the first group, 42 % had a MDR profile and 24.8 % had an XDR profile. Among studies that have evaluated the mortality of patients with P. aeruginosa bacteraemia, the results demonstrate the importance of antimicrobial resistance, inappropriate therapy and the severity of the underlying disease associated with mortality rate (Kang et al, 2005; Lodise et al, 2007;Morales et al, 2012; Suárez et al, 2010;Voor In't Holt et al, 2014). Our data are similar to those, and showed that patients with cancer and those who received inappropriate antimicrobial therapy were independent factors associated with mortality.…”

“…Severe infections such as bloodstream infection and ventilator-associated pneumonia (VAP) due to multidrugresistant (MDR) Pseudomonas aeruginosa result in greater morbidity and mortality, longer hospitalization and higher cost than infections caused by susceptible bacteria (Morales et al, 2012; Suárez et al, 2010;Voor In't Holt et al, 2014), and aspects related to epidemiology and the outcome of patients with these infections may change, resulting in high rates of resistance and as consequence difficulties in treatment (Kang et al, 2005; Lodise et al, 2007).…”

Bloodstream infections in neutropenic cancer patients: A practical update

“…17,18 Finally, healthcare costs are increased in case of infections with resistant bacteria due to prolonged hospitalization and expensive antibiotic treatments. 19,20 Fluconazole prophylaxis has significantly reduced infections caused by Candida spp, making Aspergillus the most frequent fungal pathogen during prolonged neutropenia. 21,22 Thus, fungal bloodstream infections, Arterial hypoxemia (PaO2/FiO2 < 300), Acute oliguria (output < 0.5 ml/kg £ min), Creatinine increase > 0.5 mg/dL, Coagulation abnormalities (international normalized ratio > 1.5, Activated partial thromboplastin time > 60 s), Ileus, Thrombocytopenia (< 100,000/mL), Hyperbilirubinemia (plasma total bilirubin > 4 mg/dL or 70 mmol/L) Tissue perfusion parameters: Hyperlactatemia ( > 3 mmol/L), Decreased capillary filling or mottling.…”

Environmental contaminants in hospital settings and progress in disinfecting techniques

“…Every year, millions of people across the world suffer from HAIs. HAIs are a wide-ranging concern in the medical field, not only because of morbidity and the possibly of lethal consequences for patients, but also because of extended hospital stays and associated high costs [2][3][4][5].…”