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

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.