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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 ,
Hsin-Chun Lee ,
Nai-Ying Ko ,
Chia-Ming Chang ,
Hsin-I Shih ,
Chi-Jung Wu  and
Wen-Chien Ko
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 ([email protected])
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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
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 6 , June 2007 , pp. 713 - 719
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Acar, JF. Consequences of bacterial resistance to antibiotics in medical practice. Clin Infect Dis 1997;24(suppl 1): S17–S18.Google Scholar
2.Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1987;9:1065–1078.CrossRefGoogle ScholarPubMed
3.Urban, C, Segal-Maurer, S, Rahal, JJ. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis 2003;36:1268–1274.CrossRefGoogle ScholarPubMed
4.Bergogne-Berezin, E, Towner, KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev 1996;9:148–165.CrossRefGoogle ScholarPubMed
5.Cisneros, JM, Rodriguez-Bano, J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect 2002;8:687–693.Google Scholar
6.Seifert, H, Strate, A, Pulverer, G. Nosocomial bacteremia due to Acinetobacter baumannii: clinical features, epidemiology, and predictors of mortality. Medicine (Baltimore) 1995;74:340–349.CrossRefGoogle ScholarPubMed
7.Cisneros, JM, Reyes, MJ, Pachon, J, et al.Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:1026–1032.CrossRefGoogle ScholarPubMed
8.McCabe, WR, Jackson, GG. Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 1962;110:847–855.Google Scholar
9.Le Gall, JR, Lemeshow, S, Saulnier, F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.CrossRefGoogle ScholarPubMed
10.Yu, VL, Chiou, CC, Feldman, C, et al.An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome. Clin Infect Dis 2003;37:230–237.CrossRefGoogle ScholarPubMed
11.Paterson, DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43(suppl 2): S43–S48.CrossRefGoogle ScholarPubMed
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
13.Pittet, D, Tarara, D, Wenzel, RRNosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
14.Fagon, JY, Chastre, J, Novara, A, Medioni, P, Gibert, C. Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model. Intensive Care Med 1993;19:137–144.CrossRefGoogle ScholarPubMed
15.VonGraevenitz, A. Acinetobacter, Alcaligenes, Moraxella, and other non-fermentative gram-negative bacteria. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, eds. Manual of Clinical Microbiology. 6th ed. Washington, DC: American Society for Microbiology; 1995:520–532.Google Scholar
16.National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution: Antimicrobial Susceptibility Testing for Bacteria That Grow Aerobically. 4th ed. Villanova, PA: NCCLS; 1997. NCCLS document M7-A3.Google Scholar
17.National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. Am J Infect Control 1996;24:380–388.CrossRefGoogle Scholar
18.National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.CrossRefGoogle Scholar
19.Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:1433–1437.Google ScholarPubMed
20.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(suppl 2): S82–S89.Google Scholar
21.Sheng, WH, Chie, WC, Chen, YC, Hung, CC, Wang, JT, Chang, SC. Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients. J Formos Med Assoc 2005;104:318–326.Google ScholarPubMed
22.Wilson, SJ, Knipe, CJ, Zieger, MJ, et al.Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital. Am J Infect Control 2004;32:342–344.Google Scholar
23.Jellison, TK, McKinnon, PS, Rybak, MJ. Epidemiology, resistance, and outcomes of Acinetobacter baumannii bacteremia treated with imipenem-cilastatin or ampicillin-sulbactam. Pharmacotherapy 2001;21:142–148.CrossRefGoogle ScholarPubMed
24.Blot, S, Vandewoude, K, De Bacquer, D, Colardyn, F. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis 2002;34:1600–1606.CrossRefGoogle ScholarPubMed
25.Raymond, DP, Pelletier, SJ, Crabtree, TD, Evans, HL, Pruett, TL, Sawyer, RG. Impact of antibiotic-resistant gram-negative bacilli infections on outcome in hospitalized patients. Crit Care Med 2003;31:1035–1041.CrossRefGoogle ScholarPubMed
26.Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.CrossRefGoogle ScholarPubMed
27.Carmeli, Y, Troillet, N, Karchmer, AW, Samore, MH. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159:1127–1132.CrossRefGoogle ScholarPubMed
28.Zaragoza, R, Artero, A, Camarena, JJ, Sancho, S, Gonzalez, R, Nogueira, JM. The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit. Clin Microbiol Infect 2003;9:412–418.CrossRefGoogle Scholar