Contributing Factors to the Clinical and Economic Burden of Patients with Laboratory-Confirmed Carbapenem-Nonsusceptible Gram-Negative Urinary Tract Infections

Abstract

Eilish McCann,1 Anita H Sung,1 Gang Ye,2 Latha Vankeepuram,2 Ying P Tabak2 1Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA; 2Digital Health, Medical Affairs, Becton, Dickinson and Company, Franklin Lakes, NJ, USACorrespondence: Eilish McCannCenter for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USATel [phone]Email [email protected]: We explored patient- and hospital-level predictor variables for worse clinical and economic outcomes in carbapenem-nonsusceptible urinary tract infections (UTIs).Patients and Methods: We used electronic data (January 2013–September 2015; 78 US hospitals) from a large multicenter clinical database. Nonduplicate gram-negative isolates were considered carbapenem-nonsusceptible if they had resistant/intermediate susceptibility. Potential predictors of outcomes (mortality, 30-day readmissions, length of stay [LOS], hospital total cost, and net gain/loss per case) were examined using generalized linear mixed models. Significant predictors were identified based on statistical significance and model goodness-of-fit criteria.Results: A total of  1439 carbapenem-nonsusceptible urine cases were identified. The mortality rate was 5.5%; the hospital readmission rate was 25.0%. Mean (standard deviation [SD]) LOS, total cost, and loss per case were 12 (14) days, $21,502 ($37,172), and $5828 ($26,540), respectively. Hospital-onset (vs community-onset) infection significantly impacted all outcomes: mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.19– 4.11; P=.01), 30-day readmissions (OR, 2.35; 95% CI, 1.49– 3.71; P<.001), LOS (25.7 vs 10.2 days; P<.001), hospital total cost ($67,810 vs $22,141; P<.001), and loss per case (–$28,054 vs –$10,809; P<.001). Mechanical ventilation/intensive care unit status, neoplasms, and other underlying diseases were also common predictors for worse outcomes overall; polymicrobial infection was significantly associated with worse economic outcomes. Other key predictors were > 1 prior hospitalization for 30-day readmissions, high Acute Laboratory Risk of Mortality Score for mortality, LOS, cost, and hospital teaching status for cost.Conclusion: Hospital-onset infections, polymicrobial infections, higher clinical severity, and underlying diseases are key predictors for worsened overall burden of carbapenem-nonsusceptible gram-negative UTIs.Keywords: bacterial drug resistance, health care costs, hospital costs, patient outcome assessment, risk assessment

Keywords

• bacterial drug resistance
• health care costs
• hospital costs
• patient outcome assessment
• risk assessment