Abstract
BackgroundPseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease.MethodsTwo hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders.ResultsPseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases.ConclusionsPseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.
Highlights
Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge
Three categories of cases should be differentiated when estimating the cost of Pseudomonas aeruginosa-related pneumonia [15]: (1) Hospital-acquired pneumonia (HAP), where pneumonia is detected more than 48 h after admission and by definition is not the main reason for hospitalization
We developed the following 5-step approach: Analysis of HAP We used regression models with a within-maindiagnosis time-to-exposure stratification approach that allows for appropriate treatment of the time-dependent exposure, while accounting for the clustering of costs within main diagnosis groups
Summary
Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Community-acquired cases account for a considerable number of hospitalizations [1, 2], and hospital-acquired pneumonia is a common complication in both ventilated [3] and non-ventilated [4] patients. A relatively limited set of bacterial species have been identified as causing a large number of the hospital-acquired bacterial cases, i.e. Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella species, Escherichia coli, Acinetobacter species, and Enterobacter species [7]. Pseudomonas aeruginosa is a frequent causative agent of pneumonia in hospitalized patients [12], immunocompromised hosts, and patients with cystic fibrosis [13], it is a common cause of communityacquired infection [14] and is responsible for considerable additional healthcare costs and resource utilization [12]. Multidrug-resistance (MDR) introduces additional difficulty and might be an important variable in explaining the burden of pneumonia
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