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. 2020 Feb 21;15(2):e0229393.
doi: 10.1371/journal.pone.0229393. eCollection 2020.

Attributable burden in patients with carbapenem-nonsusceptible gram-negative respiratory infections

Ying P Tabak  1 , Anita Sung  2 , Gang Ye  1 , Latha Vankeepuram  1 , Vikas Gupta  1 , Eilish McCann  2
Affiliations

Attributable burden in patients with carbapenem-nonsusceptible gram-negative respiratory infections

Ying P Tabak et al. PLoS One. .

Abstract

Objective: We aimed to describe the clinical and economic burden attributable to carbapenem-nonsusceptible (C-NS) respiratory infections.

Methods: This retrospective matched cohort study assessed clinical and economic outcomes of adult patients (aged ≥18 years) who were admitted to one of 78 acute care hospitals in the United States with nonduplicate C-NS and carbapenem-susceptible (C-S) isolates from a respiratory source. A subset analysis of patients with principal diagnosis codes denoting bacterial pneumonia or other diagnoses was also conducted. Isolates were classified as community- or hospital-onset based on collection time. A generalized linear mixed model method was used to estimate the attributable burden for mortality, 30-day readmission, length of stay (LOS), cost, and net gain/loss (payment minus cost) using propensity score-matched C-NS versus C-S cohorts.

Results: For C-NS cases, mortality (25.7%), LOS (29.4 days), and costs ($81,574) were highest in the other principal diagnosis, hospital-onset subgroup; readmissions (19.4%) and net loss (-$9522) were greatest in the bacterial pneumonia, hospital-onset subgroup. Mortality and readmissions were not significantly higher for C-NS cases in any propensity score-matched subgroup. Significant C-NS-attributable burden was found for both other principal diagnosis subgroups for LOS (hospital-onset: 3.7 days, P = 0.006; community-onset: 1.5 days, P<0.001) and cost (hospital-onset: $12,777, P<0.01; community-onset: $2681, P<0.001).

Conclusions: Increased LOS and cost burden were observed in propensity score-matched patients with C-NS compared with C-S respiratory infections; the C-NS-attributable burden was significant only for patients with other principal diagnoses.

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Conflict of interest statement

YPT, GY, LV, and VG are employees of Becton, Dickinson and Company, Franklin Lakes, NJ, USA. EM is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA (MSD). AS was an employee of MSD at the time of manuscript preparation. This does not alter our adherence to PLOS ONE’s policies on sharing data and materials.

Figures

Fig 1
Fig 1. C-NS versus C-S case tree.
BP, bacterial pneumonia; C-NS, carbapenem nonsusceptible; C-S, carbapenem susceptible; CO, community-onset; HO, hospital-onset; PDX, principal diagnosis.
Fig 2
Fig 2. Outcomes by propensity score-matched patient cohorts (carbapenem-nonsusceptible [C-NS; grey bars] cases versus carbapenem-susceptible [C-S; open bars] cases).
(A) Mortality. (B) 30-Day readmission. 30-Day readmission was only measured in patients who were alive at discharge. (C) Length of stay (LOS). BP, bacterial pneumonia; CI, confidence interval; CO, community onset; HO, hospital onset; PDX, principal diagnosis.
Fig 3
Fig 3
Total cost (A) and net gain/loss (B) by propensity score-matched patient cohorts. BP, bacterial pneumonia; C-NS, carbapenem nonsusceptible; C-S, carbapenem susceptible; CI, confidence interval; CO, community-onset; HO, hospital-onset; PDX, principal diagnosis; USD, United States dollars.
See this image and copyright information in PMC

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