Cost of Gram-negative resistance

Area of Science:

• Infectious Diseases
• Health Economics
• Critical Care Medicine

Background:

• Gram-negative rod (GNR) infections pose a significant challenge in healthcare settings.
• The impact of infections caused by antibiotic-resistant GNR (rGNR) versus susceptible GNR (sGNR) on patient morbidity and resource utilization remains unclear.

Purpose of the Study:

• To test the hypothesis that rGNR infections are associated with higher resource utilization compared to sGNR infections.
• To quantify the economic burden and resource utilization associated with rGNR infections in surgical patients.

Main Methods:

• Retrospective observational cohort study using prospectively collected data from a university hospital's surgical intensive care unit and ward.
• Comparison of outcomes between surgical patients with rGNR infections and those with sGNR infections.
• Analysis included total hospital costs, length of stay, antibiotic costs, in-hospital death, and ICU length of stay, with multivariate regression to control for confounders.

Main Results:

• rGNR infections were associated with higher severity of illness (APACHE II score).
• Median hospital costs were significantly higher for rGNR infections ($80,500 vs. $29,604) and antibiotic costs were also elevated ($2,607 vs. $758).
• rGNR infections led to longer median hospital stays (29 vs. 13 days) and ICU stays (13 vs. 1 day). Early rGNR infection (<7 days) independently predicted increased hospital costs.

Conclusions:

• Early infection with rGNR is linked to a substantial economic burden, partly due to increased antibiotic use.
• The findings underscore the importance of controlling antibiotic overuse to mitigate the economic impact of resistant infections.
• Interventions aimed at antibiotic stewardship are crucial for managing healthcare costs associated with rGNR infections.