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Clinical Outcomes and Healthcare Utilization Related to Multidrug-Resistant Gram-Negative Infections in Community Hospitals

Published online by Cambridge University Press:  11 October 2016

Kristen V. Dicks ,
Deverick J. Anderson ,
Arthur W. Baker ,
Daniel J. Sexton  and
Sarah S. Lewis
Kristen V. Dicks*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Arthur W. Baker
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Sarah S. Lewis
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
*
Address correspondence to Kristen V. Dicks, MD, MPH, PO Box 102359, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710 (kristen.dicks@duke.edu).
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Abstract

OBJECTIVE

To evaluate the impact of multidrug-resistant gram-negative rod (MDR-GNR) infections on mortality and healthcare resource utilization in community hospitals.

DESIGN

Two matched case-control analyses.

SETTING

Six community hospitals participating in the Duke Infection Control Outreach Network from January 1, 2010, through December 31, 2012.

PARTICIPANTS

Adult patients admitted to study hospitals during the study period.

METHODS

Patients with MDR-GNR bloodstream and urinary tract infections were compared with 2 groups: (1) patients with infections due to nonMDR-GNR and (2) control patients representative of the nonpsychiatric, non-obstetric hospitalized population. Four outcomes were assessed: mortality, direct cost of hospitalization, length of stay, and 30-day readmission rates. Multivariable regression models were created to estimate the effect of MDR status on each outcome measure.

RESULTS

No mortality difference was seen in either analysis. Patients with MDR-GNR infections had 2.03 higher odds of 30-day readmission compared with patients with nonMDR-GNR infections (95% CI, 1.04–3.97, P=.04). There was no difference in hospital direct costs between patients with MDR-GNR infections and patients with nonMDR-GNR infections. Hospitalizations for patients with MDR-GNR infections cost $5,320.03 more (95% CI, $2,366.02–$8,274.05, P<.001) and resulted in 3.40 extra hospital days (95% CI, 1.41–5.40, P<.001) than hospitalizations for control patients.

CONCLUSIONS

Our study provides novel data regarding the clinical and financial impact of MDR gram-negative bacterial infections in community hospitals. There was no difference in mortality between patients with MDR-GNR infections and patients with nonMDR-GNR infections or control patients.

Infect Control Hosp Epidemiol 2016;1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 31 - 38
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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