OBJECTIVES To analyze the clinical and economic burden of community-acquired (CA) or community-onset healthcare-associated (COHCA) multidrug-resistant (MDR) infections requiring hospitalization. METHODS Case-control study. Adults admitted with CA or COHCA MDR infections were considered cases, while those admitted in the same period with non-MDR infections were controls. The matching criteria were source of infection and/or microorganism. Primary outcome was 30-day clinical failure. Secondary outcomes were 90-day and 1-year mortality, hospitalization costs and resource consumption. RESULTS 194 patients (97 cases and 97 controls) were included. Multivariate analysis identified age (odds ratio [OR], 1.07, 95% confidence interval [CI], 1.01-1.14) and SOFA score (OR, 1.45, CI95%, 1.15-1.84) as independent predictors of 30-day clinical failure. Age (hazard ratio [HR] 1.09, 95%CI, 1.03-1.16) was the only factor associated with 90-day mortality, whereas age (HR 1.06, 95%CI, 1.03-1.09) and Charlson Index (HR 1.2, 95%CI, 1.07-1.34) were associated with 1-year mortality. MDR group showed longer hospitalization (p<0.001) and MDR hospitalization costs almost doubled those in the non-MDR group. MDR infections were associated with higher antimicrobial costs. CONCLUSIONS Worse economic outcomes were identified with community-onset MDR infections. MDR was associated with worse clinical outcomes but mainly due to higher comorbidity of patients in MDR group, rather than multidrug resistance.

中文翻译：

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需要住院治疗的社区发作的多药耐药性感染的临床和经济负担。

目的分析需要住院的社区获得性（CA）或社区发作的医疗相关（COHCA）多药耐药（MDR）感染的临床和经济负担。方法病例对照研究。认为患有CA或COHCA MDR感染的成人为病例，而同期非MDR感染的成人为对照组。匹配标准是感染源和/或微生物。主要结果是30天临床失败。次要结果是90天和1年死亡率，住院费用和资源消耗。结果纳入194例患者（97例和97例对照）。多变量分析将年龄（赔率[OR]，1.07、95％置信区间[CI]，1.01-1.14）和SOFA评分（OR，1.45，CI95％，1.15-1.84）确定为30天临床失败的独立预测因素。年龄（危险比[HR] 1.09、95％CI，1.03-1.16）是与90天死亡率相关的唯一因素，而年龄（HR 1.06、95％CI，1.03-1.09）和查尔森指数（HR 1.2、95） ％CI（1.07-1.34）与1年死亡率相关。MDR组的住院时间更长（p <0.001），MDR住院费用几乎是非MDR组的两倍。耐多药感染与较高的抗菌药物成本相关。结论社区引发的MDR感染确定了较差的经济结果。MDR与较差的临床结果相关，但主要是由于MDR组患者合并症较高，而不是多重耐药性。34）与1年死亡率相关。MDR组的住院时间更长（p <0.001），MDR住院费用几乎是非MDR组的两倍。耐多药感染与较高的抗菌药物成本相关。结论社区引发的MDR感染确定了较差的经济结果。MDR与较差的临床结果相关，但主要是由于MDR组患者合并症较高，而不是多重耐药性。34）与1年死亡率相关。MDR组的住院时间更长（p <0.001），MDR住院费用几乎是非MDR组的两倍。耐多药感染与更高的抗菌药物成本相关。结论社区引发的MDR感染确定了较差的经济结果。MDR与较差的临床结果相关，但主要是由于MDR组患者合并症较高，而不是多重耐药性。