The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study

Abstract

BackgroundInfections due to multi-drug resistant gram negative bacilli (RGNB) in critically ill patients have been reported to be associated with increased morbidity and costs and only a few studies have been done in Asia. We examined the financial impact of nosocomial RGNB infections among critically ill patients in Singapore.MethodsA nested case control study was done for patients at medical and surgical ICUs of a tertiary university hospital (August 2007-December 2011) matched by propensity scores. Two groups of propensity-matched controls were selected for each case patient with nosocomial drug resistant gram negative infection: at-risk patients with no gram negative infection or colonization (Control A) and patients with ICU acquired susceptible gram negative infection (SGNB) (Control B). The costs of the hospital stay, laboratory tests and antibiotics prescribed as well as length of stay were compared using the Wilcoxon matched-pairs signed rank test.ResultsOf the 1539 patients included in the analysis, 76 and 65 patients had ICU acquired RGNB and SGNB infection respectively. The median(range) total hospital bill per day for patients with RGNB infection was 1.5 times higher than at-risk patients without GNB infection [Singapore dollars 2637.8 (458.7-20610.3) vs. 1757.4 (179.9-6107.4), p0.0001]. The same trend was observed when compared with SGNB infected patients. The median costs per day of antibiotics and laboratory investigations were also found to be significantly higher for patients with RGNB infection. The length of stay post infection was not found to be different between those infected with RGNB and SGNB.ConclusionThe economic burden of RGNB infections to the patients and the hospital is considerable. Efforts need to be taken to prevent their occurrence by cost effective infection control practices.

Risk factors for multidrug‐resistant Gram‐negative bacteria infection in intensive care units: A meta‐analysis

“…Eight studies (Costa et al, ; Lye et al, ; Marcos et al, ; Nseir et al, ; Osthoff et al, ; Vasudevan et al, ; Venkatachalam et al, ; Zhong et al, ) reported a significant relationship between previous antibiotic therapy and MDR‐GNB infection (Figure A). The fixed effects model was chosen due to moderate heterogeneity in this meta‐analysis ( I 2 = 43.2%, P <0.10).…”

“…Ten studies (Alexiou et al, ; Michalopoulos et al, ; Nseir et al, ; Osthoff et al, ; Prata‐Rocha et al, ; Vasudevan et al, ; Vasudevan et al, ; Venkatachalam et al, ; Zhong et al, ) reported the correlation between a diagnosis of diabetes mellitus and MDR‐GNB infection (Figure ). With no evidence of heterogeneity ( I 2 = 0%, P >0.10), pooled results showed no statistically significant difference between the 2 groups; diabetes mellitus wasn't shown as a risk factor for infection with MDR‐GNB in ICUs (OR 1.18, 95% CI 0.95–1.47).…”

“…Seventeen studies (Alexiou et al, 2012;Costa, Atta, & Silva, 2015;Fang, Chen, & Zhou, 2016;Katsaragakis et al, 2008;Liu et al, 2015;Lye et al, 2012;Marcos et al, 2011;Michalopoulos et al, 2011;Osthoff, Mcguinness, Wagen, & Eisen, 2015;Patel et al, 2014; Prata-Rocha, Gontijo-Filho, & Melo, 2012;Tsai et al, 2016;Vasudevan, Memon, Mukhopadhyay, Li, & Tambyah, 2015;Vasudevan, Mukhopadhyay, Li, Yuen, & Tambyah, 2014;Venkatachalam et al, 2014;Young, Sabel, & Price, 2007;Zhong et al, 2012) reported the correlation of gender and MDR-GNB infection ( Figure 2). The random effect model was used to pool results (I 2 = 75.4%, P < 0.001).…”

High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal

“…Nevertheless, in the recent years, therapeutic drugs are being progressively ineffective against bacterial infections, threatning the success of routine treatment [7]. The major consequences of this problem are increased patient morbidity, mortality, health care related expenses and treatment failure [8, 9]. …”

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.…”