Highlights
- •Community-onset multidrug-resistant (MDR) infections are increasing.
- •Clinical and economic burden of community-onset MDR infections were evaluated.
- •Community-onset MDR infections had longer hospital stay and higher costs.
- •Multidrug resistance was related to sicker patients and thus to worse outcomes.
- •Multidrug resistance could be a marker of more complicated and expensive admissions.
Summary
Objectives
To analyze the clinical and economic burden of community-acquired (CA) or community-onset
healthcare-associated (CO HCA) multidrug-resistant (MDR) infections requiring hospitalization.
Methods
Case-control study. Adults admitted with CA or CO HCA MDR infections were considered cases, while those admitted in the same period
with non-MDR infections were controls. The matching criteria were source of infection
and/or microorganism. Primary outcome was 30-day clinical failure. Secondary outcomes
were 90-day and 1-year mortality, hospitalization costs and resource consumption.
Results
194 patients (97 cases and 97 controls) were included. Multivariate analysis identified
age (odds ratio [OR], 1.07, 95% confidence interval [CI], 1.01–1.14) and SOFA score
(OR, 1.45, CI95%, 1.15–1.84) as independent predictors of 30-day clinical failure.
Age (hazard ratio [HR] 1.09, 95%CI, 1.03–1.16) was the only factor associated with
90-day mortality, whereas age (HR 1.06, 95%CI, 1.03–1.09) and Charlson Index (HR 1.2,
95%CI, 1.07–1.34) were associated with 1-year mortality. MDR group showed longer hospitalization
(p<0.001) and MDR hospitalization costs almost doubled those in the non-MDR group. MDR
infections were associated with higher antimicrobial costs.
Conclusions
Worse economic outcomes were identified with community-onset MDR infections. MDR was
associated with worse clinical outcomes but mainly due to higher comorbidity of patients
in MDR group, rather than multidrug resistance.
Keywords
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Article info
Publication history
Published online: January 06, 2020
Accepted:
December 31,
2019
Identification
Copyright
© 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
