Economic Burden of Carbapenem-Resistant Organisms in Critically Ill Patients: A Multicenter, Retrospective Cohort...

Carbapenem-resistant organisms (CROs) are a growing threat in intensive care units (ICUs) worldwide due to the limited treatment options and high risk of morbidity and mortality. While previous studies have assessed the clinical implications of CROs, few have systematically quantified their economic burden.

This study aimed to evaluate the economic burden attributable to CROs compared with carbapenem-susceptible organisms (CSOs) among critically ill patients in China.

We conducted a retrospective cohort study including 7,232 ICU patients from two tertiary hospitals in Western China (2019-2024). Patients were assigned to either the CRO group or the CSO group and matched using a 1:1 propensity score matching (PSM) approach. ICU length of stay (LOS), hospital LOS, and total hospitalization cost were compared between the two groups, followed by generalized linear models (GLMs) to assess the independent impact of CRO status. Institutional-level opportunity costs were estimated based on excess ICU occupancy.

Among the 7,232 patients, 379 (5.24%) developed CRO, with carbapenem-resistant Acinetobacter baumannii (CRAB) being the predominant pathogen. PSM produced 379 pairs of CRO and CSO patients. The CRO group had significantly longer ICU LOS (median 11.0 vs 5.0 days, P<0.001), longer hospital LOS (median 24.0 vs 13.0 days, P<0.001), and higher total hospitalization costs (median CNY 99,549 vs CNY 50,279, P<0.001) than the CSO group. GLMs showed that CRO independently predicted longer ICU LOS (OR: 2.37; 95% CI: 2.03-2.76), longer hospital LOS (OR: 1.97; 95% CI: 1.70-2.27), and higher total hospitalization costs (OR: 1.99; 95% CI: 1.78-2.23). An estimated 321 hospital admissions and 459 ICU admissions were lost over six years due to excess bed occupancy by CRO patients, resulting in a total institutional financial loss of approximately CNY 134,000 per year.

CROs are associated with substantially increased economic burden in ICU patients. These findings support the implementation of early screening, targeted prevention, and stewardship strategies to mitigate the impact of CROs.