Background. This analysis investigates the prevalence, mortality impact, health service utilization and cost of current treatments of multi-drug resistant (MDR) Acinetobacter baumannii (ACB) in the US, identified by the CDC as an urgent and serious threat to public health.
Methods. Hospital costs and utilization were evaluated using the Premier Hospital Database, a large US hospital administrative database containing data elements available in hospital discharge files including diagnoses and procedures categorized according to ICD-9 codes, culture results, antimicrobial susceptibility tests, and antibiotics used to treat infections. Data were extracted for the years 2009-3Q2013. Microbiologic confirmation of Acinetobacter was obtained from 152 hospitals of vrying size. Analyses compared healthcare outcomes in patients with MDR isolates vs non-MDR isolates.
Results. Over the 57-month period, 367 subjects with a primary pneumonia diagnosis and 1,869 with a primary sepsis diagnosis were identified. Unadjusted, al-cause in-hospital mortality among pneumonia patients was 15.46% vs 5.88% for non-MDR patients. Mean (median) length of hospital stay in days (LOS) was 13.4 (9) days vs 10.5 (7) days; hospital costs [mean (median)] were $32,086 ($20,763) vs $24,367 ($13,005); percentage of patients requiring ICU was 47.59% vs 22.55%. Mortality among sepsis/septicemia patients was 21.67% vs 16.91% for non-MDR patients. Mean (and median) LOS was 16.2 (11) days vs 14.8 (9) days; hospital costs [mean (median)] were $43,997 ($26,663) vs $38,494 ($19,974); percentage of patients requiring ICU was 62.81% vs 46.84%. The most frequently used drugs to treat MDR infections were carbapenems (56.02%, tigecycline (26.32%) and colistin (15.03%).
Conclusion. MDR ACB infections incur substantially higher mortality, healthcare resource utilization and costs compared to non-MDR infections. Carbapenems are the most frequently used treatment for MDR ACB, while tigecycline is the most frequently added drug to carbapenem treatment. The value of safe and effective treatments of infections due to Acinetobacter sp. is considerable in view of the additional cost and mortality associated with MDR ACB.
Disclosures. K. T. Lapensee, The Medicines Company: Employee, Salary W. Fan, The Medicines Company: Employee, Salary M. Redell, The Medicines Company: Employee, Salary M. Dudley, The Medicines Company: Employee, Salary J. Loutit, The Medicines Company: Employee, Salary