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Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection

Dominique Vandijck (UGent) , Stijn Blot (UGent) , Johan Decruyenaere (UGent) , Raymond Vanholder (UGent) , Jan De Waele (UGent) , Norbert Lameire (UGent) , Stefaan Claus (UGent) , Johan De Schuijmer (UGent) , Annemieke Dhondt (UGent) , Gerda Verschraegen (UGent) , et al.
(2008) ACTA CLINICA BELGICA. 63(1). p.31-38
Author
Organization
Abstract
Introduction: Antimicrobial resistance negatively impacts on prognosis. Intensive care unit (ICU) patients, and particularly those with acute kidney injury (AKI), are at high risk for developing nosocomial bloodstream infections (BSI) due to multi-drug-resistant strains. Economic implications in terms of costs and length of stay (LOS) attributable to antimicrobial resistance are underevaluated. This study aimed to assess whether microbial susceptibility patterns affect costs and LOS in a well-defined cohort of ICU patients with AKI undergoing renal replacement therapy (RRT) who developed nosocomial BSI. Methods: Historical study (1995-2004) enrolling all adult RRT-dependent ICU patients with AKI and nosocomial BSI. Costs were considered as invoiced in the Belgian reimbursement system, and LOS was used as a surrogate marker for hospital resource allocation. Results: Of the 1330 patients with AKI undergoing RRT, 92 had microbiologic evidence of nosocomial BSI (57/92,62% due to a multi-drug-resistant micro- organism). Main patient characteristics were equal in both groups. As compared to patients with antimicrobial-susceptible BSI, patients with antimicrobial-resistant BSI were more likely to acquire Gram; positive infection (72.6% vs 25.5%, P<0.001). No differences were found neither in LOS (ICU before BSI, ICU, hospital before BSI, hospital, hospital after BSI, and time on RRT; all P>0.05) or hospital costs (all P>0.05) when comparing patients with antimicrobial-resistant vs anti microbial-susceptible ! BSI. However, although not statistically significant, patients with BSI caused by resistant Gram-negative-, Candida-, or anaerobic bacteria incurred substantial higher costs than those without. Conclusion: In a cohort of ICU patients with AKI and nosocomial BSI undergoing RRT, patients with antimicrobial-resistant vs antimicrobial-susceptible Gram-positive BSI did not have longer hospital stays, or higher hospital costs. Patients with resistant "other" (i.e. Gram-negative, Candida, or anaerobic) BSI were found to have a distinct trend towards increased resources use as compared to patients with susceptible "other" BSI, respectively.
Keywords
SURVEILLANCE CULTURES, METHICILLIN-RESISTANT, ECONOMIC OUTCOMES, ICU, DEFINITIONS, GRAM-NEGATIVE BACTERIA, ACUTE-RENAL-FAILURE, length of stay, STAPHYLOCOCCUS-AUREUS, INTENSIVE-CARE-UNIT, CRITICALLY-ILL PATIENTS, intensive care, antimicrobial resistance, acute kidney injury, bloodstream infection, costs, economic

Citation

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MLA
Vandijck, Dominique, et al. “Costs and Length of Stay Associated with Antimicrobial Resistance in Acute Kidney Injury Patients with Bloodstream Infection.” ACTA CLINICA BELGICA, vol. 63, no. 1, 2008, pp. 31–38.
APA
Vandijck, D., Blot, S., Decruyenaere, J., Vanholder, R., De Waele, J., Lameire, N., … Hoste, E. (2008). Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection. ACTA CLINICA BELGICA, 63(1), 31–38.
Chicago author-date
Vandijck, Dominique, Stijn Blot, Johan Decruyenaere, Raymond Vanholder, Jan De Waele, Norbert Lameire, Stefaan Claus, et al. 2008. “Costs and Length of Stay Associated with Antimicrobial Resistance in Acute Kidney Injury Patients with Bloodstream Infection.” ACTA CLINICA BELGICA 63 (1): 31–38.
Chicago author-date (all authors)
Vandijck, Dominique, Stijn Blot, Johan Decruyenaere, Raymond Vanholder, Jan De Waele, Norbert Lameire, Stefaan Claus, Johan De Schuijmer, Annemieke Dhondt, Gerda Verschraegen, and Eric Hoste. 2008. “Costs and Length of Stay Associated with Antimicrobial Resistance in Acute Kidney Injury Patients with Bloodstream Infection.” ACTA CLINICA BELGICA 63 (1): 31–38.
Vancouver
1.
Vandijck D, Blot S, Decruyenaere J, Vanholder R, De Waele J, Lameire N, et al. Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection. ACTA CLINICA BELGICA. 2008;63(1):31–8.
IEEE
[1]
D. Vandijck et al., “Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection,” ACTA CLINICA BELGICA, vol. 63, no. 1, pp. 31–38, 2008.
@article{395462,
  abstract     = {{Introduction: Antimicrobial resistance negatively impacts on prognosis. Intensive care unit (ICU) patients, and particularly those with acute kidney injury (AKI), are at high risk for developing nosocomial bloodstream infections (BSI) due to multi-drug-resistant strains. Economic implications in terms of costs and length of stay (LOS) attributable to antimicrobial resistance are underevaluated. This study aimed to assess whether microbial susceptibility patterns affect costs and LOS in a well-defined cohort of ICU patients with AKI undergoing renal replacement therapy (RRT) who developed nosocomial BSI.
Methods: Historical study (1995-2004) enrolling all adult RRT-dependent ICU patients with AKI and nosocomial BSI. Costs were considered as invoiced in the Belgian reimbursement system, and LOS was used as a surrogate marker for hospital resource allocation.
Results: Of the 1330 patients with AKI undergoing RRT, 92 had microbiologic evidence of nosocomial BSI (57/92,62% due to a multi-drug-resistant micro- organism). Main patient characteristics were equal in both groups. As compared to patients with antimicrobial-susceptible BSI, patients with antimicrobial-resistant BSI were more likely to acquire Gram; positive infection (72.6% vs 25.5%, P<0.001). No differences were found neither in LOS (ICU before BSI, ICU, hospital before BSI, hospital, hospital after BSI, and time on RRT; all P>0.05) or hospital costs (all P>0.05) when comparing patients with antimicrobial-resistant vs anti microbial-susceptible ! BSI. However, although not statistically significant, patients with BSI caused by resistant Gram-negative-, Candida-, or anaerobic bacteria incurred substantial higher costs than those without.
Conclusion: In a cohort of ICU patients with AKI and nosocomial BSI undergoing RRT, patients with antimicrobial-resistant vs antimicrobial-susceptible Gram-positive BSI did not have longer hospital stays, or higher hospital costs. Patients with resistant "other" (i.e. Gram-negative, Candida, or anaerobic) BSI were found to have a distinct trend towards increased resources use as compared to patients with susceptible "other" BSI, respectively.}},
  author       = {{Vandijck, Dominique and Blot, Stijn and Decruyenaere, Johan and Vanholder, Raymond and De Waele, Jan and Lameire, Norbert and Claus, Stefaan and De Schuijmer, Johan and Dhondt, Annemieke and Verschraegen, Gerda and Hoste, Eric}},
  issn         = {{0001-5512}},
  journal      = {{ACTA CLINICA BELGICA}},
  keywords     = {{SURVEILLANCE CULTURES,METHICILLIN-RESISTANT,ECONOMIC OUTCOMES,ICU,DEFINITIONS,GRAM-NEGATIVE BACTERIA,ACUTE-RENAL-FAILURE,length of stay,STAPHYLOCOCCUS-AUREUS,INTENSIVE-CARE-UNIT,CRITICALLY-ILL PATIENTS,intensive care,antimicrobial resistance,acute kidney injury,bloodstream infection,costs,economic}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{31--38}},
  title        = {{Costs and length of stay associated with antimicrobial resistance in acute kidney injury patients with bloodstream infection}},
  volume       = {{63}},
  year         = {{2008}},
}

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