Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China

Cheng, Vincent CC; Wong, Sally CY; Ho, Pak-Leung; Yuen, Kwok-Yung

Multidrug-resistant organisms complicate clinical treatment and increase cost. Hospital antibiotic costs were higher in the penicillinresistant S. pneumoniae group compared with penicillin-susceptible S. pneumoniae (Canadian dollars 211 vs. 74; P50.02) in a case-control study. 37 In a case-control analysis from Israel for patients with ESBLproducing Enterobacteriaceae, the median length of stay after bacteremia was 11 days for cases (interquartile range: 5-21) versus 5 days for controls (interquartile range: 3-9) (P,0.001). The average hospital cost was Israeli shekels 65 509 for cases versus 23 538 for controls (P,0.001). After adjusting for differences between groups using multivariable analysis, ESBL production remained a significant predictor for increased length of hospital stay (1.56-fold; P50.001) and increased cost (1.57-fold; P50.003). 38 Cost analysis of patients with nosocomial MRSA infections also showed that MRSA infection was independently associated with higher hospitalization costs (median of US$18129.89 vs. US$4490.47; P,0.001) and higher post-discharge healthcare-associated financial costs (median of US$337.24 vs. US$259.29; P50.021) in a matched case-control study in an endemic area. 39 The impact of carbapenem resistance on cost outcomes among patients with P. aeruginosa and A. baumannii infection was also studied. Compared with patients infected with imipenem-susceptible P. aeruginosa, patients infected with imipenem-resistant P. aeruginosa had longer hospitalizations (15.5 days vs. 9 days; P50.02) and greater hospital costs (US$81 330 vs. US$48 381; P,0.001). 40 The average total cost of hospitalization among patients with CRAB was significantly higher than that among patients with carbapenem-susceptible A. baumannii in a multivariate analysis (adjusted cost, US$11 359 vs. US$7049; P,0.001). 41 The cost of a medical intensive care unit closure due to an outbreak of CRAB in a hospital was estimated to be J216 553, while the cost of waste elimination and cleaning procedures was about J12 000. The cost of drug and non-cleanable equipment destruction was approximately J36 000, and the estimated direct cost of the intensive care unit closure was J264 553. 42