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Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections

Published online by Cambridge University Press:  13 July 2016

Richard E. Nelson ,
Marin L. Schweizer ,
Eli N. Perencevich ,
Scott D. Nelson ,
Karim Khader ,
Hsiu-Yin Chiang ,
Margaret L. Chorazy ,
Amy Blevins ,
Melissa A. Ward  and
Matthew H. Samore
Richard E. Nelson*
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Marin L. Schweizer
Affiliation:
Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Eli N. Perencevich
Affiliation:
Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Scott D. Nelson
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
Karim Khader
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Hsiu-Yin Chiang
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Margaret L. Chorazy
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Amy Blevins
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Melissa A. Ward
Affiliation:
Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Matthew H. Samore
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
*
Address correspondence to Richard E. Nelson, PhD, 500 Foothill Blvd, Salt Lake City, UT 84148 (richard.nelson@utah.edu).
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Abstract

BACKGROUND

Our objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies.

METHODS

We identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections.

RESULTS

Our estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10–32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%–29.4%). With an incidence rate of 0.141 (95% CI, 0.136–0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509–13,625) in the United States.

CONCLUSION

The estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs.

Infect Control Hosp Epidemiol 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1212 - 1218
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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