Effect of multiple drug resistance on total medical costs among patients with intra-abdominal infections in China

BACKGROUND Multiple drug resistant (MDR) intra-abdominal infections (IAIs) are associated with notable direct and societal costs. As previous studies have not considered the impact of MDR on the total medical costs (TMCs) of IAIs, the present one examines this, as well as further estimates the additional costs at a national level. METHODS This is a retrospective study. Firstly, we randomly selected a sample of 40% of all inpatients discharged between 2014 and 2015 from a teaching hospital, due to limits in budget and the large number of patients. Then, we manually selected 254 patients with IAIs according to the International Classification of Disease, 10th revision, using electronic medical records. Eventually, 101 patients with IAIs (64 MDR patients and 37 non-MDR patients) were included after excluding cases without laboratory test results, any pathogens detected, or antimicrobial resistant pathogens. Univariate analysis and a generalized linear model were applied to assess the parameters associated with TMCs. RESULTS Compared to non-MDR patients, those with MDR pathogens were significantly associated with higher TMCs, higher antimicrobial costs, higher antimicrobial usage, larger number of pathogens, and longer length of stay and were more likely to have insurance and combination antimicrobial therapy. In addition, the average TMC among patients with MDR pathogens was ¥ 131801, which is ¥ 90201 higher than those without MDR pathogens. If our results are applied to the whole country, the sum of all attributable TMCs was ¥ 37 billion. The societal costs, furthermore, were ¥111 billion in 2015. CONCLUSION Our results provide information that should lead to increased efforts to reduce inappropriate antimicrobial therapy, in order to decrease the emergence of MDR pathogens and to reduce their economic burden.