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Cost of Gram-negative resistance.
Crit Care Med. 2007 Jan; 35(1):89-95.CC

Abstract

OBJECTIVE

It is unclear that infections with Gram-negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization.

DESIGN

Retrospective observational cohort study of prospectively collected data.

SETTING

University hospital surgical intensive care unit and ward.

PATIENTS

Surgical patients with at least one GNR infection.

MEASUREMENTS

We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in-hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders.

MAIN RESULTS

Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 +/- 0.6 vs. 13.9 +/- 0.3), had higher median hospital costs ($80,500 vs. $29,604, p < .0001) and median antibiotic costs ($2,607 vs. $758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at $11,075; 95% confidence interval, $3,282-$20,099).

CONCLUSIONS

Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.

Authors+Show Affiliations

Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17110877

Citation

Evans, Heather L., et al. "Cost of Gram-negative Resistance." Critical Care Medicine, vol. 35, no. 1, 2007, pp. 89-95.
Evans HL, Lefrak SN, Lyman J, et al. Cost of Gram-negative resistance. Crit Care Med. 2007;35(1):89-95.
Evans, H. L., Lefrak, S. N., Lyman, J., Smith, R. L., Chong, T. W., McElearney, S. T., Schulman, A. R., Hughes, M. G., Raymond, D. P., Pruett, T. L., & Sawyer, R. G. (2007). Cost of Gram-negative resistance. Critical Care Medicine, 35(1), 89-95.
Evans HL, et al. Cost of Gram-negative Resistance. Crit Care Med. 2007;35(1):89-95. PubMed PMID: 17110877.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost of Gram-negative resistance. AU - Evans,Heather L, AU - Lefrak,Shayna N, AU - Lyman,Jason, AU - Smith,Robert L, AU - Chong,Tae W, AU - McElearney,Shannon T, AU - Schulman,Alison R, AU - Hughes,Michael G, AU - Raymond,Daniel P, AU - Pruett,Timothy L, AU - Sawyer,Robert G, PY - 2006/11/18/pubmed PY - 2007/1/20/medline PY - 2006/11/18/entrez SP - 89 EP - 95 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 1 N2 - OBJECTIVE: It is unclear that infections with Gram-negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization. DESIGN: Retrospective observational cohort study of prospectively collected data. SETTING: University hospital surgical intensive care unit and ward. PATIENTS: Surgical patients with at least one GNR infection. MEASUREMENTS: We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in-hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders. MAIN RESULTS: Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 +/- 0.6 vs. 13.9 +/- 0.3), had higher median hospital costs ($80,500 vs. $29,604, p < .0001) and median antibiotic costs ($2,607 vs. $758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at $11,075; 95% confidence interval, $3,282-$20,099). CONCLUSIONS: Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17110877/Cost_of_Gram_negative_resistance_ DB - PRIME DP - Unbound Medicine ER -