Clinical and Economic Burden of Multi-drug Resistant Pseudomonas sp. (MDRP) Among Patients With Serious Infections in United States Hospitals

Abstract

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, $4045 more in total in-hospital costs, and $7395 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. (Figure Presented) .