Clinical and Economic Impact of Multidrug Resistance in Nosocomial <i>Acinetobacter baumannii</i> Bacteremia

<jats:sec id="S0195941700046531_abs1"><jats:title>Objective.</jats:title><jats:p>To investigate the impact of antimicrobial resistance on clinical and economic outcomes among hospitalized patients with multidrug-resistant (MDR) <jats:italic>Acinetobacter baumannii</jats:italic> bacteremia.</jats:p></jats:sec><jats:sec id="S0195941700046531_abs2"><jats:title>Design.</jats:title><jats:p>A retrospective, matched-cohort study.</jats:p></jats:sec><jats:sec id="S0195941700046531_abs3"><jats:title>Setting.</jats:title><jats:p>A tertiary care university teaching hospital</jats:p></jats:sec><jats:sec id="S0195941700046531_abs4"><jats:title>Methods.</jats:title><jats:p>A matched case-control (1:1) study was conducted to compare the differences in clinical and economic outcomes of patients with MDR <jats:italic>A. baumannii</jats:italic> bacteremia and patients with non-MDR <jats:italic>A. baumannii</jats:italic> bacteremia. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness, and length of hospital stay before onset of bacteremia.</jats:p></jats:sec><jats:sec id="S0195941700046531_abs5"><jats:title>Results.</jats:title><jats:p>Forty-six (95.8%) of 48 cases with MDR A. <jats:italic>baumannii</jats:italic> bacteremia were eligible for the study and matched with appropriate controls. The sepsis-related mortality rate was 34.8% among cases and 13.0% among controls, for an attributable mortality rate of 21.8% (adjusted odds ratio, 4.1 [95% confidence interval, 1.1-15.7]; <jats:italic>P</jats:italic> = .036). After the onset of bacteremia, cases and controls had a significantly different length of hospital stay (54.2 vs 34.1 days; <jats:italic>P</jats:italic> = .006), hospitalization cost (US$9,349 vs US$4,865; <jats:italic>P</jats:italic> = .001 ), and antibiotic therapy cost (US$2,257 vs US$1,610; <jats:italic>P</jats:italic> = .014). Thus, bacteremia due to MDR <jats:italic>A. baumannii</jats:italic> resulted in 13.4 days of additional hospitalization and US$3,758 of additional costs, compared with bacteremia due to non-MDR <jats:italic>A. baumannii</jats:italic>.</jats:p></jats:sec><jats:sec id="S0195941700046531_abs6"><jats:title>Conclusions.</jats:title><jats:p>Patients with MDR <jats:italic>A. baumannii</jats:italic> bacteremia had a higher mortality rate and incurred greater medical costs than patients with non-MDR <jats:italic>A. baumannii</jats:italic> bacteremia.</jats:p></jats:sec>