Journal Article

Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship

Ahmad, Ibrar, Naples, Jeremy, Roberts, Rebecca R., Hota, Bala, Abbasi, Fauzia, Foster, Susan D., Weinstein, Robert A., Scott, R. Douglas, Schabowski, Shari, Kampe, Linda M., Cordell, Ralph, Ciavarella, Ginevra G., Levy, Stuart B., Supino, Mark

2009

Overview

Background. Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI). Methods. A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI. Results. In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from $18,588 to $29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4–12.7 days, and attributable mortality was 6.5%. The societal costs were $10.7–$15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort. Conclusions. The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Adult / Aged / Anti-Bacterial Agents - economics / Anti-Bacterial Agents - therapeutic use / Antibacterial agents / Antibiotics. Antiinfectious agents. Antiparasitic agents / Antimicrobial agents / Antimicrobials / APACHE / ARTICLES AND COMMENTARIES / Bacterial Infections - drug therapy / Bacterial Infections - economics / Bacterial Infections - microbiology / Bacterial Infections - mortality / Biological and medical sciences / Chicago / Comorbidity / Drug resistance / Drug Resistance, Bacterial / Drug Utilization - economics / Drug Utilization - standards / Economic costs / Female / Health Care Costs / Health care expenditures / Hospital costs / Hospitals, Teaching / Humans / Infections / Infectious diseases / Intensive care units / Length of Stay / Male / Medical sciences / Middle Aged / Mortality / Nosocomial infections / Organizational Policy / Pharmacology. Drug treatments / Prevention programs / Sensitivity analysis / Studies / Teaching hospitals