Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections

Thaden, Joshua T.; Li, Yanhong; Ruffin, Felicia; Maskarinec, Stacey A.; Hill-Rorie, Jonathan; Wanda, Lisa; Reed, Shelby D.; Fowler, Vance G.

doi:10.1128/aac.01709-16

Cited by 77 publications

(59 citation statements)

References 47 publications

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“…57 For example, one study found that the mean inpatient cost for MDR-E. coli was $18,917 compared with non-MDR E. coli, which was $14,776. 58 In the same study, the cost difference was greater for MDR versus non-MDR K. pneumoniae versus non-MDR with mean inpatient cost of $115,868 versus $28,877, respectively. Imipenem-resistant P. aeruginosa has been associated with an attributable cost of $85,299 compared with imipenem-susceptible P. aeruginosa.…”

Section: Health Care Burden Attributable Mortality and Costmentioning

confidence: 88%

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Strich

Kadri

2019

Semin Respir Crit Care Med

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Antibiotic resistance among gram-negative pathogens is a world-wide problem that poses a constant threat to patients in the intensive care unit and a therapeutic challenge for the intensivist. Furthermore, the substantial economic burden and increased mortality associated with infections due to highly resistant gram-negative pathogens exacerbate these challenges. Understanding the mechanisms, epidemiology, and risk factors for these infections is paramount to the successful control of outbreaks and for guiding therapy which often entails use of antibiotics with suboptimal efficacy and/or toxicity profiles. In this review we will discuss the global epidemiology, burden, risk factors, and treatment of highly resistant gram-negative infections as they apply to the intensive care population.

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Section: Health Care Burden Attributable Mortality and Costmentioning

confidence: 88%

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Strich

Kadri

2019

Semin Respir Crit Care Med

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“…Regarding the site of acquisition, the bacteremia was categorized as either hospital- or community-acquired [ 15 ]. Hospital-acquired bacteremia was defined as the bacteremia diagnosed ≥48 hours after hospital admission [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

The Risk of Cardiac Device-Related Infection in Bacteremic Patients Is Species Specific: Results of a 12-Year Prospective Cohort

Maskarinec

Thaden

Cyr

et al. 2017

Open Forum Infectious Diseases

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BackgroundThe species-specific risk of cardiac device-related infection (CDRI) among bacteremic patients is incompletely understood.MethodsWe conducted a prospective cohort study of hospitalized patients from October 2002 to December 2014 with a cardiac device (CD) and either Staphylococcus aureus bacteremia (SAB) or Gram-negative bacteremia (GNB). Cardiac devices were defined as either prosthetic heart valves (PHVs), including valvular support rings, permanent pacemakers (PPMs)/automatic implantable cardioverter defibrillators (AICDs), or left ventricular assist devices (LVADs).ResultsDuring the study period, a total of 284 patients with ≥1 CD developed either SAB (n = 152 patients) or GNB (n = 132 patients). Among the 284 patients, 150 (52.8%) had PPMs/AICDs, 72 (25.4%) had PHVs, 4 (1.4%) had LVADs, and 58 (20.4%) had >1 device present. Overall, 54.6% of patients with SAB and 16.7% of patients with GNB met criteria for definite CDRI (P < .0001). Multivariable logistic regression analysis revealed that 3 bacterial species were associated with an increased risk for CDRI: Staphylococcus aureus (odds ratio [OR] = 5.57; 95% confidence interval [CI], 2.16–14.36), Pseudomonas aeruginosa (OR = 50.28; 95% CI, 4.16–606.93), and Serratia marcescens (OR = 7.75; 95% CI, 1.48–40.48).ConclusionsRisk of CDRI among patients with bacteremia varies by species. Cardiac device-related infection risk is highest in patients with bacteremia due to S aureus, P aeruginosa, or S marcescens. By contrast, it is lower in patients with bacteremia due to other species of Gram-negative bacilli. Patients with a CD who develop bacteremia due to either P aeruginosa or S marcescens should be considered for diagnostic imaging to evaluate for the presence of CDRI.

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“…We recently reviewed peer-reviewed literature published between 2000 and 2015 and found only seven studies that examined changes in drug resistance in GNB HAIs [19-25]. Although one recently published study described an association between multidrug resistance and history of GNB bloodstream infections [26], the primary objective of the study was to measure costs associated with multidrug resistance rather than to focus on recurrent infections.…”

Section: Introductionmentioning

confidence: 99%

Risk of drug resistance in repeat gram-negative infections among patients with multiple hospitalizations

Agarwal

Larson

2018

Journal of Critical Care

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Purpose Drug resistance in gram-negative bacterial hospital-acquired infections (GNB HAIs) has become ubiquitous in recent years. Patients who experience multiple hospitalizations are at high risk of developing repeat GNB HAIs. This study aims to evaluate the relationship between repeat GNB HAIs and antibiotic susceptibility patterns. Methods Using electronic medical records from three hospitals, 4053 patients were identified with at least one HAI caused by K. pneumoniae or P. aeruginosa over multiple hospitalizations in a 9-year period. Modified Poisson regression was used to evaluate the risk of drug resistance with increasing number of prior susceptible infections. Drug resistance was defined as resistant to carbapenems for K. pneumoniae and resistant to levofloxacin for P. aeruginosa. Results In patients with repeat infections, almost 15% of consecutive infections changed from susceptible to drug-resistant. Patients with K. pneumoniae infections had a 1.14 times increased risk of acquiring a drug-resistant HAI with each prior HAI, after adjusting for potential confounders and antibiotic use prior to infection. Patients with P. aeruginosa infections had a 1.23 times increased risk of a drug-resistant infection with each prior P. aeruginosa HAI. Conclusions Prevention of repeat infections in high healthcare utilizers may be important in reducing drug resistance in this population.

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Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections

Cited by 77 publications

References 47 publications

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

The Risk of Cardiac Device-Related Infection in Bacteremic Patients Is Species Specific: Results of a 12-Year Prospective Cohort

Risk of drug resistance in repeat gram-negative infections among patients with multiple hospitalizations

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