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Early Factors Related to Healthcare Utilization by Infection Status among Combat Injured.

Laveta Stewart1,2, Faraz Shaikh1,2, Erica Sercy1,2

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Multidrug-resistant Gram-negative bacilli infections in wounded military personnel significantly increase hospitalization duration and healthcare resource utilization. Addressing these infections is crucial for managing combat casualty care costs and optimizing resource allocation within the Military Health System.

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Area of Science:

  • Medical Research
  • Infectious Diseases
  • Military Medicine

Background:

  • Combat casualty care incurs substantial healthcare costs.
  • The impact of battlefield-related infections on healthcare utilization remains incompletely understood.
  • Assessing factors associated with hospitalization based on infection outcomes is critical for resource management.

Purpose of the Study:

  • To evaluate factors associated with hospitalization among wounded military personnel.
  • To compare healthcare utilization based on infection status, specifically multidrug-resistant Gram-negative bacilli (MDR-GNB) infections versus other pathogens and no infection.
  • To identify predictors of prolonged hospitalization in combat casualties.

Main Methods:

  • Retrospective analysis of electronic medical records for deployed military personnel wounded between June 2009 and December 2014.
  • Patients admitted to Landstuhl Regional Medical Center and transferred to US military hospitals were included.
  • Classification based on infection: MDR-GNB, other pathogens, or no infection; assessment of healthcare utilization within two weeks post-injury.

Main Results:

  • Patients with MDR-GNB infections had significantly longer hospital stays (median 59.5 days) compared to other infections (42 days) and no infections (22 days).
  • MDR-GNB infections were associated with increased critical care, more frequent clinical cultures, and longer antimicrobial use (median 51 days).
  • After adjusting for covariates, MDR-GNB infections added an estimated 5 days to hospitalization for every 30 days compared to other infections.

Conclusions:

  • Infections caused by multidrug-resistant Gram-negative bacilli substantially increase the healthcare burden in combat casualty care.
  • These findings highlight the significant resource utilization associated with MDR-GNB infections within the Military Health System.
  • Further research into incremental healthcare costs is needed to inform resource allocation for treating these complex infections.