William R Judd1, Patrick D Ratliff2, Ryan P Hickson3, Dana M Stephens4, Charles A Kennedy5. 1. Department of Pharmacy Services, Saint Joseph Hospital, Lexington, KY. Electronic address: juddwr@sjhlex.org. 2. Department of Pharmacy Services, Saint Joseph Hospital, Lexington, KY. 3. Division of Pharmaceutical Outcomes and Policy, The University of North Carolina at Chapel Hill, Chapel Hill, NC. 4. Department of Infection Control, Saint Joseph Hospital, Lexington, KY. 5. Division of Infectious Diseases, Saint Joseph Hospital, Lexington, KY; Lexington Infectious Disease Consultants, Lexington, KY.
Abstract
BACKGROUND: The emergence of carbapenem resistance has had a significant impact on both clinical and economic outcomes. METHODS: A retrospective, observational cohort study was performed in a 433-bed tertiary care medical center. The cohort was established from all inpatients with Pseudomonas aeruginosa-positive cultures over a 3-year period. Two multivariate models were developed: a logistic regression model to evaluate the primary outcome of in-hospital mortality and a linear regression model to evaluate the secondary outcome of total hospital cost. RESULTS: The adjusted odds ratio for in-hospital mortality among patients with meropenem-resistant isolates was 2.89 (95% confidence interval [CI], 1.15-7.28). There were significantly more deaths in the meropenem-resistant group (28.1% vs 8.9%, P = .003). Patients with meropenem-resistant P aeruginosa experienced a 4-day increase in median length of stay versus those in the meropenem-susceptible group (14 vs 9 days, P = .004). Likewise, the percentage of patients who required intensive care unit (ICU) admission increased from 42% to 81.3% (P <.001). Meropenem resistance was also associated with a significant increase in total hospital cost by a factor of 1.42 among patients who were not admitted to the ICU (95% CI, 1.03-1.95). CONCLUSIONS: Our results demonstrate that meropenem resistance was a significant predictor of in-hospital mortality. Carbapenem resistance also resulted in a significant increase in hospital cost, but only among patients who were not admitted to the ICU.
BACKGROUND: The emergence of carbapenem resistance has had a significant impact on both clinical and economic outcomes. METHODS: A retrospective, observational cohort study was performed in a 433-bed tertiary care medical center. The cohort was established from all inpatients with Pseudomonas aeruginosa-positive cultures over a 3-year period. Two multivariate models were developed: a logistic regression model to evaluate the primary outcome of in-hospital mortality and a linear regression model to evaluate the secondary outcome of total hospital cost. RESULTS: The adjusted odds ratio for in-hospital mortality among patients with meropenem-resistant isolates was 2.89 (95% confidence interval [CI], 1.15-7.28). There were significantly more deaths in the meropenem-resistant group (28.1% vs 8.9%, P = .003). Patients with meropenem-resistant P aeruginosa experienced a 4-day increase in median length of stay versus those in the meropenem-susceptible group (14 vs 9 days, P = .004). Likewise, the percentage of patients who required intensive care unit (ICU) admission increased from 42% to 81.3% (P <.001). Meropenem resistance was also associated with a significant increase in total hospital cost by a factor of 1.42 among patients who were not admitted to the ICU (95% CI, 1.03-1.95). CONCLUSIONS: Our results demonstrate that meropenem resistance was a significant predictor of in-hospital mortality. Carbapenem resistance also resulted in a significant increase in hospital cost, but only among patients who were not admitted to the ICU.
Authors: B Borgatta; S Gattarello; C A Mazo; A T Imbiscuso; M N Larrosa; M Lujàn; J Rello Journal: Eur J Clin Microbiol Infect Dis Date: 2017-06-17 Impact factor: 3.267
Authors: A Olowo-Okere; Y K E Ibrahim; B O Olayinka; J O Ehinmidu; Y Mohammed; L Z Nabti; J-M Rolain; S M Diene Journal: New Microbes New Infect Date: 2020-08-01
Authors: Michelle L Brown; Johann Motsch; Keith S Kaye; Thomas M File; Helen W Boucher; Neika Vendetti; Angela Aggrey; Hee-Koung Joeng; Robert W Tipping; Jiejun Du; Daryl D DePestel; Joan R Butterton; Amanda Paschke Journal: Open Forum Infect Dis Date: 2020-02-19 Impact factor: 3.835