With healthcare systems across the nation focused on the COVID-19 pandemic, other priorities have largely gone by the wayside, including the formidable and longstanding problem of multidrug-resistant organisms (MDROs). Difficult to treat with the existing formulary, these bacteria beset hospitalized patients with costly infections that have high morbidity and mortality.

A paper published recently quantifies the costs of these infections, finding that it costs $30,998 (range: $25,272 to $36,724) to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. The price goes up considerably for MDROs that respond to few antibiotics. For example, carbapenem-resistant (CR) Acinetobacter costs $74,306 (range: $20,377 to $128,235) for treatment.

“What’s interesting is that on a per-infection basis, CR-Acinetobacter infections are extremely high-cost, but the sheer prevalence of the MRSA infections made those the biggest driver for overall costs, says lead author Richard Nelson, PhD, a professor of healthcare economics and infectious diseases at the University of Utah School of Medicine in Salt Lake City. “At a population level, the MRSA infections are extremely expensive.”

The goal of this large research study was to generate national-level estimates of the economic burden of drug-resistant infections in the United States.

“Treatment of these infections cost an estimated $4.6 billion ($4.1 billion to $5.1 billion) in 2017 in the U.S. for community- and hospital-onset infections combined,” Nelson and colleagues concluded.

The staggering price tag raises the inevitable question of how much money could be saved with fully staffed infection prevention programs and antibiotic stewardship programs.

“Putting a dollar amount on these negative outcomes that these patients incur is a way to show the value of the resources that could be used [for prevention] and treatment,” Nelson says. “Those resources could be very valuable if we prevented these infections.”

Neil Clancy, MD, who was not an author of the paper, commented on the costs of MDROs.

“The patients that are most vulnerable, either in the community or the hospital, to these types of highly resistant pathogens are ones in whom costs accumulate quite rapidly,” says Clancy, an infectious disease physician at the VA Pittsburgh Health System. “These are ICU (intensive care unit) patients, transplant, and other immunosuppressed patients. It really puts it in stark terms. On the one hand it is costs, but on the other [it shows] how investment up front to tackle these infections actually can be quite cost-effective.”

This is also a clear message from the COVID-19 pandemic: Investing in preparation for an infection disease event costs a lot less than when its consequences are unleashed.

“If these things emerge and start causing big problems, that money up front can save money and lives down the road,” he says. Acinetobacter is a good example of a bug that really can be controlled by infection prevention, he says.

“We see an awful lot of Acinetobacter infections associated with respiratory tract and burn infections in ICUs,” Clancy said. “A number of the respiratory tract infections are associated with ventilators. A lot of these are down to just scrupulous infection prevention with ICU patients — care of burns and wounds, managing the ventilator and respiratory tract.”

Lacking this level of care, expensive outbreaks can occur.

Acinetobacter tends to get into ICUs and cause outbreaks where a number of patients get infected — often due to infection prevention lapses,” Clancy said. “Tightening up infection prevention is what breaks the outbreak. These are relatively small investments in the grand scheme of the $5 billion investment for the costs of these [infections] in the paper.”

Many aspects of medical care are being rethought as the coronavirus pandemic exposed gaps and wasted resources in healthcare. In that regard, Clancy was asked if this thought of investing in prevention could take hold: preventing MDROs before they can harm patients and drive up costs.

“I would hope so, but the track record in the U.S. for long-term attention to problems after they quiet down a bit isn’t necessarily the greatest.”

REFERENCE

  1. Nelson RE, Hatfield KM, Wolford H, et al. National estimates of healthcare costs associated with multidrug-resistant bacterial infections among hospitalized patients in the United States. Clin Infect Dis 2021;72:S17-S26.