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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Eva Morales, Francesc Cots, Maria Sala, Mercè Comas, Francesc Belvis, Marta Riu, Margarita Salvadó, Santiago Grau, Juan P Horcajada, Maria Milagro Montero, Xavier Castells
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

EM carried out the statistical analyses and drafted the manuscript. MC and FB contributed statistical advice for analyses. MS, SG were involved in data collection and laboratory analysis. FC, MS, MR and XC participated in the design and coordination of the study and helped to draft the manuscript. JPH and MMM helped to draft the manuscript. All authors read and approved the final manuscript.

Abstract

Background

We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.

Methods

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.

Results

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).

Conclusions

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.
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