1835. Clinical and Economic Burden of Hospitalized Patients with Serious Infections due to Carbapenem Resistant Enterobacteriaceae (CRE)
Session: Poster Abstract Session: Treatment of HAIs/Antimicrobial Resistant Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: While infections caused by resistant bacteriae are generally known to result in higher rates of mortality, greater healthcare costs, and extended lengths of stay in hospital, there is limited knowledge on the clinical and economic burden of CRE.

Methods: Using Premier database, which contains information from ~150 US hospitals, we identified all patients aged ≥18 yrs hospitalized between July 1, 2011 and September 30, 2014 with evidence of complicated intra-abdominal infections, complicated urinary tract infections, hospital-acquired pneumonia, or bloodstream infections. The date of the earliest positive culture for Gram-negative bacteria was deemed the “index date”, and attention was limited to patients with Enterobacteriaceae on this date. CRE was defined as an index isolate that was non-susceptible (i.e., “resistant” or “intermediate”) to ≥1 carbapenems. Because demographic, clinical, and hospital characteristics differed significantly between patients with and without CRE, we used multivariate regression models to compare  total costs to hospital, duration of antibiotic therapy, and length of stay (all assessed from index date to discharge), as well as in-hospital mortality between the two groups.

Results: A total of 700 CRE patients and 53,652 non-CRE patients met all selection criteria. Relative to non-CRE patients, CRE patients averaged 7.4 more days in hospital and $13,545 in total in-hospital costs  (Table); corresponding multivariate-adjusted differences were 2.8 and $4,012, respectively (p<0.01 for all comparisons).  CRE patients were nominally, albeit not statistically significantly more likely to die in-hospital. 

Table. In-hospital outcomes and costs among hospitalized patients with and without CRE 

 

CRE

(N=700)

Non-CRE

(N=53,652)

p-value

Mean (SD) LOS, d

17.3 (19.1)

9.9 (14.0)

<0.01

Mean (SD) total costs, $

32,325 (45,474)

18,780 (32,134)

<0.01

Mortality, %

12.0

7.0

0.20

Conclusion: The clinical and economic consequences associated with patients infected with CRE in US hospitals are substantial. Our findings highlight the need for more effective treatment options in this patient population.

Rosa Wang, MHA1, Thomas Lodise, PharmD, PhD2, Tarun Bhagnani, MS1, Qi Zhao, MD, MPH3, Sharvari Bhurke, MS1 and Ariel Berger, MPH1, (1)Evidera, Inc, Lexington, MA, (2)Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, (3)Actavis, Inc, Jersey City, NJ

Disclosures:

R. Wang, Actavis, Inc: Research Contractor , Research support

T. Lodise, Actavis, Inc: Consultant , Consulting fee

T. Bhagnani, Actavis, Inc: Research Contractor , Research support

Q. Zhao, Actavis, Inc: Employee , Salary

S. Bhurke, Actavis, Inc: Research Contractor , Research support

A. Berger, Actavis, Inc: Research Contractor , Research support

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.