BACKGROUND Multi-drug resistant (MDR) Pseudomonas aeruginosa can negatively affect patients and hospitals. AIM To evaluate excess mortality and cost burden among patients hospitalized with suspected respiratory infections due to MDR P. aeruginosa vs patients with non-MDR P. aeruginosa in 78 United States (US) hospitals. METHODS This study analyzed electronically captured microbiological and outcomes data of patients hospitalized with non-duplicate P. aeruginosa isolates from respiratory sources collected ≥3 days after admission to identify hospital-onset MDR or non-MDR P. aeruginosa per the Centers for Disease Control and Prevention definition. The risk of multi-drug resistance was estimated on mortality, length of stay (LOS), cost, operation gain/loss, and 30-day readmission. A sensitivity analysis was conducted utilizing a cohort with pharmacy data available. FINDINGS Of 523 MDR and 1381 non-MDR P. aeruginosa cases, unadjusted mortality was 23.7% vs 18.0% and multi-variable-adjusted mortality was 20.0% (95% confidence interval (CI): 14.3-27.2%) vs 15.5% (95% CI: 11.2-20.9%; P=0.026), the average adjusted excess LOS was 6.7 days (P<0.001); excess cost per case was US$22,370 higher (P=0.002) and operational loss per case was US$10,661 (P=0.024) greater, and the multi-variable adjusted readmission rate was 16.2% (95% CI: 11.2-22.9%) vs 11.1% (95% CI: 7.8-15.6%; P=0.006). The sensitivity analysis yielded similar results. CONCLUSIONS Compared with suspected infections due to non-MDR P. aeruginosa, patients with MDR P. aeruginosa had higher risk of mortality, readmission, and longer LOS, as well as US$20,000 incremental cost and >US$10,000 incremental net loss per case after controlling for patient and hospital characteristics.

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在美国，由于多药耐药的铜绿假单胞菌引起的可疑呼吸道感染的临床和经济负担增加。

背景技术多重耐药性（MDR）的铜绿假单胞菌会对患者和医院产生负面影响。目的评估78家美国（美国）医院中因MDR铜绿假单胞菌引起的怀疑呼吸道感染住院患者与非MDR铜绿假单胞菌住院患者的过高死亡率和成本负担。方法本研究分析了入院≥3天后从呼吸源采集的非重复铜绿假单胞菌分离株住院患者的电子捕获微生物学和结局数据，以根据疾病控制和预防中心确定医院发病的MDR或非MDR铜绿假单胞菌。预防定义。根据死亡率，住院天数（LOS），成本，手术收益/损失和30天再入院，估算出多药耐药的风险。利用队列以及可获得的药房数据进行敏感性分析。在523例MDR和1381例非MDR铜绿假单胞菌病例中，未调整死亡率为23.7％对18.0％，多变量调整死亡率为20.0％（95％置信区间（CI）：14.3-27.2％）对15.5％（ 95％CI：11.2-20.9％； P = 0.026），平均调整过剩LOS为6.7天（P <0.001）；每个案例的超额成本增加了22,370美元（P = 0.002），每个案例的运营损失增加了10,661美元（P = 0.024），多变量调整后的再入院率是16.2％（95％CI：11.2-22.9％） 11.1％（95％CI：7.8-15.6％； P = 0.006）。敏感性分析得出相似的结果。结论与非MDR铜绿假单胞菌引起的可疑感染相比，MDR铜绿假单胞菌患者的死亡，再入院和更长的LOS风险更高，为20美元，