Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.

Eva Morales, Francesc Cots, Maria Sala, Mercè Comas, Francesc Belvis, Marta Riu, Margarita Salvadó, Santiago Grau, Juan P Horcajada, Maria Milagro Montero, Xavier Castells

BMC health services research 2012 May 23

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We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively). P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

Citation

Eva Morales, Francesc Cots, Maria Sala, Mercè Comas, Francesc Belvis, Marta Riu, Margarita Salvadó, Santiago Grau, Juan P Horcajada, Maria Milagro Montero, Xavier Castells. Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. BMC health services research. 2012 May 23;12:122