Stewardship / Resistance Scan for Jan 08, 2018

Cost of VRE infections
Drug-resistant Acinetobacter

VRE infections associated with significant costs, study finds

A case-control study by German investigators has found that nosocomial infections caused by vancomycin-resistant enterococci (VRE) are costlier than those caused by vancomycin-susceptible enterococci (VSE), according to a new study in Antimicrobial Resistance & Infection Control.

VRE infections are known to result in more invasive procedures, additional antibiotic therapy, and extended time in the hospital, and studies conducted in the United States have found a considerable impact on hospital costs. But to date, no such studies have been conducted in Europe. This study, performed at a tertiary care hospital in Hanover, Germany, set out to determine the costs that are directly attributed to vancomycin resistance by comparing hospital costs of VRE and VSE infections. The investigators also determined factors that may be associated with increased costs of VRE patients.

In the study, 42 cases with VRE infections and 42 controls with VSE infections admitted from January 2005 to December 2008 were matched for type of infection, age, gender, admission and discharge within the same year, Charlson Comorbidity Index (± 1), and time at risk for infection. Median overall costs per case were significantly higher for VRE patients compared with controls (€57,675 vs. €38,344, or $69,001 vs. $45,874), with no significant difference in costs between the two groups before onset of infection (€17,893 vs. €16,600, or $21,407 vs. $19,860) but much higher per-patient costs for VRE patients after onset of infection (€37,971 vs. €23,025, or $45,431 vs. $27,546). The median attributable costs per case for vancomycin resistance were €13,157 ($15,742).

Detailed analysis of the costs after onset of infection showed that the major drivers of cost differences were pharmaceuticals, nursing staff, medical products, and assistant medical technicians. Multivariate analysis revealed that VRE infection was independently associated with a 1.4-fold increase in total costs per patient.

"These results emphasize the importance of strategies for the prevention of VRE spread in the hospital," the authors write.
Jan 5 Antimicrob Resist Infect Control study


ICU risk factors for multidrug-resistant Acinetobacter baumannii identified

In another case-control study in Antimicrobial Resistance and Infection Control, researchers in China identified risk factors associated with multidrug-resistant Acinetobacter baumannii (MDR-AB) infection.

In the study, the researchers identified 489 intensive care unit (ICU) patients at three tertiary general hospitals in Xiamen, China, who had A baumannii isolated from January 2015 to December 2015. MDR-AB was detected in 39.9% of all cases (195 patients). In both MDR-AB and non-MDR-AB patients, the pathogen was commonly isolated in the respiratory tract (72.3% vs. 66.3%). Multivariate regression analysis revealed that mechanical ventilation (odds ratio [OR], 3.93), combined use of antibacterial drugs before infection (OR, 4.11), and indwelling catheters (OR, 4.15) were independent risk factors associated with MDR-AB infection.

The researchers also found that the risk of MDR-AB infections increased with higher age and longer time of mechanical ventilation.

The authors of the study say their findings could help inform future management of MDR-AB patients in ICU clinical practice.
Jan 5 Antimicrob Resist Infect Control study

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