Highlights
- •The impact of meropenem resistance in patients with Pseudomonas aeruginosa infections was assessed.
- •Meropenem resistance resulted in a 2.89-fold increase in mortality in hospitalized patients.
- •Resistance to meropenem was independently associated with increased total hospital cost.
- •A 3-tiered patient care cleaning program was effective at reducing the incidence of multidrug-resistant organisms.
Background
The emergence of carbapenem resistance has had a significant impact on both clinical
and economic outcomes.
Methods
A retrospective, observational cohort study was performed in a 433-bed tertiary care
medical center. The cohort was established from all inpatients with Pseudomonas aeruginosa–positive cultures over a 3-year period. Two multivariate models were developed: a
logistic regression model to evaluate the primary outcome of in-hospital mortality
and a linear regression model to evaluate the secondary outcome of total hospital
cost.
Results
The adjusted odds ratio for in-hospital mortality among patients with meropenem-resistant
isolates was 2.89 (95% confidence interval [CI], 1.15-7.28). There were significantly
more deaths in the meropenem-resistant group (28.1% vs 8.9%, P = .003). Patients with meropenem-resistant P aeruginosa experienced a 4-day increase in median length of stay versus those in the meropenem-susceptible
group (14 vs 9 days, P = .004). Likewise, the percentage of patients who required intensive care unit (ICU)
admission increased from 42% to 81.3% (P < .001). Meropenem resistance was also associated with a significant increase in total
hospital cost by a factor of 1.42 among patients who were not admitted to the ICU
(95% CI, 1.03-1.95).
Conclusions
Our results demonstrate that meropenem resistance was a significant predictor of in-hospital
mortality. Carbapenem resistance also resulted in a significant increase in hospital
cost, but only among patients who were not admitted to the ICU.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: June 16, 2016
Footnotes
Conflicts of Interest: None to report.
Identification
Copyright
© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into accountAmerican Journal of Infection ControlVol. 45Issue 1
- PreviewWe read with interest 2 recent articles by Wu et al1 and Judd et al2 about the economic burden of nosocomial infections (NIs). Wu et al investigated the economic impact of infections in patients with acute leukemia in China. Although much research has been published on the burden of NI, most of it has focused on high-income countries. However, many limited-resource countries experience high rates of NIs, which likely present a large burden on the respective health care system.3 To accurately evaluate the cost-effectiveness of interventions aimed at NI in these settings, more research in this field is therefore duly needed.
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