Abstract
BackgroundWe aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.MethodsA retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs.ResultsCost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively).ConclusionsP. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.
Highlights
We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition
The mean length of hospital stay (LOS) was longer among patients with resistant (39.0 days) and multi-drug resistant P. aeruginosa (45.7 days) strains than among those with non-resistant strains (25.1 days)
The use of previous anti-P. aeruginosa antibiotic therapy was more common among patients with resistant (45.4%) and multi-drug resistant P. aeruginosa (70.1%) isolates than in those with non-resistant isolates (13.4%)
Summary
We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. Infections caused by antibiotic resistant microorganisms usually result in significantly higher morbidity, longer hospitalization, increased mortality rates, and excess health care costs compared with antibiotic-susceptible microorganisms [1,2]. Pseudomonas aeruginosa is a Gram-negative bacterial pathogen that causes severe nosocomial infections [4]. Multi-drug resistance to antipseudomonal antibiotics is a common and increasing problem in some hospitals [7,8]. Infections by multi-drug resistant P. aeruginosa (MDRPA) are associated with increased morbidity [9], mortality [7,10], and economic impact [11]. Fewer studies have quantitatively examined in detail the hospital economic impact of MDRPA infections and most have been limited to case series studies and outbreaks [11,12]
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