OBJECTIVES: Antibiotic resistance (ABR) poses a threat to public health in the United States (US). The Centers for Disease Control and Prevention has identified three ABR urgent threats (defined as potential clinical and economic impact, transmissibility, available treatment, barriers to prevention): Clostridium difficile (C. diff), carbapenem-resistent Enterobacteriaceae (CRE), and Neisseria gonorrhoeae (N. gonorrhoeae). Limited data exist which document ABR-related burden in the context of inpatient care. This study examines length of stay (LOS) and costs associated with ABR urgent threat-related hospitalizations in the US.
METHODS: Using the 2001-2012 Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample databases, nationally-representative surveys of US hospitalizations, we identified hospitalizations with a diagnosis code indicating an urgent ABR threat. LOS and total costs (in 2014 US dollars) were estimated for each urgent ABR threat, for each year analyzed.
RESULTS: The number of CRE- and C. diff-related hospitalizations increased during the study period (CRE: 109,304 in 2001 to 692,680 in 2012; C. diff: 144,312 in 2001 to 359,395 in 2012) but decreased for N. gonorrhoeae (5,440 in 2001 to 4,130 in 2012). The mean LOS for all hospitalizations in the US between 2001-2012 was 4.58 days and mean per-patient cost of $16,168. LOS for all urgent threats decreased over time (LOS: N. gonorrhoeae, 2001: 4.05 days, 2012: 3.92 days; CRE, 2001: 10.15 days, 2012: 6.98 days; and C. diff, 2001: 13.53 days, 2012: 10.41 days) while total costs increased for N. gonorrhoeae, (2001: $9,963, 2012: $14,675) and C. diff(2001: $36,896, 2012: $43,632) but not for CRE (2001: $27,356, 2012: $26,959).
CONCLUSIONS: Although LOS among ABR-related hospitalizations in the US has decreased over time, costs for both N. gonorrhoeae and C. diff have increased, +47% and +18%, respectively. Future efforts to reduce the incidence of ABR infection will improve the public’s health as well as decrease the associated economic burden.
