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BACKGROUND: Antimicrobial resistance is an increasing problem. OBJECTIVE: To examine the clinical and economic impact of antibiotic resistance in Pseudomonas aeruginosa. METHODS: In-hospital mortality, secondary bacteremia, length of stay, and hospital charges were examined in a cohort of 489 inpatients with positive clinical cultures for P aeruginosa. One hundred forty-four had a resistant baseline P aeruginosa isolate and 30 had resistance emerge during follow-up. Multivariable and survival analytic methods were used to adjust for confounding and effects of time. RESULTS: The overall in-hospital mortality rate was 7. 6%, 7. 7% in patients with a resistant isolate at baseline (relative risk RR, 1. 3; 95% confidence interval CI, 0. 6-2. 8) and 27% in patients in whom resistance emerged (RR, 3. 0; 95% CI, 1. 2-7. 8). Secondary bacteremia developed in 1. 4% of patients in whom resistance did not emerge and in 14% of those in whom resistance emerged (RR, 9. 0; 95% CI, 2. 7-30). The median duration of hospital stay following the initial P aeruginosa isolate was 7 days. Emergence of resistance, but not baseline resistance, was significantly associated with a longer hospital stay (P<. 001 and P=. 71, respectively). The average daily hospital charge was 2059. Neither baseline resistance nor emergence of resistance had a significant effect on the daily hospital charge. In a matched cohort analysis, a trend was seen toward increased total charges in patients demonstrating emergence of resistance (difference, 7340; P=. 14). CONCLUSIONS: Emergence of antibiotic resistance in P aeruginosa results in severe adverse outcomes. Efforts should be directed toward early detection and prevention of emergence of antibiotic resistance.
Carmeli et al. (Mon,) studied this question.