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Clinical and economic impact of meropenem resistance in Pseudomonas aeruginosa–infected patients

      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

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      Linked Article

      • Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into account
        American Journal of Infection ControlVol. 45Issue 1
        • Preview
          We 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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