Session: Poster Abstract Session: Antimicrobial Resistant Infections: Treatment
Background: To quantify the clinical and economic burden of multi-drug resistant Pseudomonas sp. (MDRP) among hospitalized adult patients with serious infections.
Methods: Using a large hospital database, we identified admissions of adults (aged ≥18 y) between July 1, 2011 and September 30, 2014 with evidence of serious infection (eg, complicated intra-abdominal infections, hospital-acquired pneumonia, bloodstream infections). The date of the earliest positive culture for Gram-negative bacteria was deemed the “index date”, and attention was focused on patients with evidence of Pseudomonas sp. on this date. MDRP was defined as “nonsusceptible” Pseudomonas sp. to ≥3 antibiotic classes. We propensity matched MDRP patients to those with Pseudomonas sp. that were not designated MDRP (“non-MDRP”) and compared duration of antibiotic therapy, length of stay (LOS) (days), total costs to the hospital to render care and total in-hospital charges.
Results: A total of 7217 patients met selection criteria, of whom 960 (13.3%) had MDRP. In propensity-matched analyses, MDRP patients averaged 1.0 more days of antibiotic therapy, 1.2 greater LOS days, $4,045 more in total in-hospital costs, and $7,395 more in total in-hospital charges (all P≤0.01). Antibiotics represented between 3% and 4% of total in-hospital costs; room and board, between 50% and 54% (Figure 1). Discharge status/destination differed significantly between the two groups (P for overall comparison <0.01; Figure 2).
Conclusion: In a well-matched cohort, and relative to susceptible isolates, infections due to MDRP are associated with longer treatment duration, increased LOS, and higher total in-hospital costs and charges. Earlier identification of patients at risk of infection with MDRP may decrease the burden of serious infections due to Pseudomonas sp.
Table. In-hospital outcomes and costs among propensity-matched patients with MDRP*
| MDRP (N=518) | Non-MDRP (N=518) |
P-Value |
Therapy duration, d | 10.8 (9.6) | 9.8 (10.3) | <0.01 |
LOS, d | 11.5 (11.1) | 10.3 (11.2) | <0.01 |
Total cost, $ | 27,966 (47,041) | 23,921 (33,520) | 0.01 |
Total charges, $ | 93,309 (116,003) | 85,914 (135,187) | <0.01 |
*Unless otherwise noted, values are mean (SD); P-values based on Wilcoxon signed-rank tests
Disclosures:
T. P. Lodise,
Allergan, Inc:
Consultant
,
Speaker's Bureau
and
Travel fees
,
Consulting fee
,
Speaker honorarium
and
Travel fees
Merck:
Consultant
,
Consulting fee
The Medicines company:
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,
Consulting fee
T. Bhagnani, Evidera: Employee , Salary
Q. Zhao, Allergan plc: Employee , Salary
M. Ye, Allergan plc: Employee , Salary
A. Berger, Evidera: Employee , Salary