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Clinical and Economic Impact of Multidrug Resistance in Nosocomial Acinetobacter baumannii Bacteremia

Published online by Cambridge University Press:  02 January 2015

Nan-Yao Lee
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
Hsin-Chun Lee
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan Departments of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
Nai-Ying Ko
Affiliation:
Nursing, Medical College, National Cheng Kung University, Tainan, Taiwan
Chia-Ming Chang
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
Chi-Jung Wu
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
Wen-Chien Ko*
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan Departments of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
*
Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, 704, Tainan, Taiwan (winston@mail.ncku.edu.tw)

Abstract

Objective.

To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) Acinetobacter baumannii bacteremia.

Design.

A retrospective, matched-cohort study.

Setting.

A tertiary care university teaching hospital

Methods.

A matched case-control (1:1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR A. baumannii bacteremia and patients with non-MDR A. baumannii bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia.

Results.

Forty-six (95.8%) of 48 cases with MDR A. baumannii bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; P = .036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; P = .006), hospitalization cost (US$9,349 vs US$4,865; P = .001 ), and antibiotic therapy cost (US$2,257 vs US$1,610; P = .014). Thus, bacteremia due to MDR A. baumannii resulted in 13.4 days of additional hospitalization and US$3,758 of additional costs, compared with bacteremia due to non-MDR A. baumannii.

Conclusions.

Patients with MDR A. baumannii bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR A. baumannii bacteremia.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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