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BMC Health Services Research

, 12:122

First Online: 23 May 2012Received: 15 October 2010Accepted: 23 May 2012DOI: 10.1186-1472-6963-12-122

Cite this article as: Morales, E., Cots, F., Sala, M. et al. BMC Health Serv Res 2012 12: 122. doi:10.1186-1472-6963-12-122


BackgroundWe aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.

MethodsA retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona Spain. All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs.

ResultsCost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains 15,265 vs. 4,933 Euros. In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively.

ConclusionsP. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.

KeywordsAntimicrobial resistance Economic analysis Hospital cost Multi-drug resistance Pseudomonas aeruginosa AbbreviationsCIConfidence interval


HIVHuman Immunodeficiency Virus

ICUintensive care unit

LOSlength of hospital stay

MDRPAmulti-drug resistant P. aeruginosa

PAPseudomona aeruginosa.

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Autor: Eva Morales - Francesc Cots - Maria Sala - Mercè Comas - Francesc Belvis - Marta Riu - Margarita Salvadó - Santiago Grau


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