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Presentation Type:
Oral Presentation
Subject Category: MDR GNR
How Does Antimicrobial Resistance Increase Medical Costs in
Community-Acquired Acute Pyelonephritis?
Bongyoung Kim; Taul Cheong and Jungmo Ahn
Background: The proportion of antimicrobial-resistant Enterobacterales that
are causative pathogens for community-acquired acute pyelonephritis (CA-
APN) has been increasing. We examined the effect of antimicrobial resistance
on medical costs in CA-APN. Methods: A single-center retrospective cohort
study was conducted at a tertiary-care hospital in Korea between January
2018 to December 2019. All hospitalized patients aged ≥19 years who were diag-
nosed with CA-APN were recruited, and those with Enterobacterales as a causa-
tive pathogen were included. Comparisons between CA-APN caused by
extended-spectrum β-lactamase (ESBL)–producing pathogens (ESBL+ group)
and those by non–ESBL-producing organisms (ESBL–group)aswellasCA-
APN caused by ciprofloxacin-resistant pathogens (CIP-R group) and those by
ciprofloxacin-sensitive pathogens (CIP-S group) were performed. Log-linear
regression was performed to determine the risk factors for medical costs.
Results: In total, 241 patients were included in this study. Of these, 75
(31.1%) had an ESBL-producing pathogen and 87 (36.1%) had a ciprofloxa-
cin-resistant pathogen. The overall medical costs were significantly higher in
the ESBL+ group compared with the ESBL−group (US$3,730.18 vs US
$3,119.32) P <0.001) as well as in CIP-R group compared with CIP-S group
(3,730.18 USD vs. 3,119.32 USD, P =0.005). In addition, length of stay was longer
in ESBL+ group compared with ESBL-group (11 vs. 8 days, P <0.001) as well as in
CIP-R group compared with CIP-S group (11 vs. 8 days, P <0.001). There were
no significant difference in the proportion of clinical failure between ESBL+ and
ESBL- groups; CIP-R and CIP-S groups. Based on the log-linear regression
model, the costs associated with ESBL-producing Enterobacterales as the causa-
tive pathogen would be, on average, 27%higherorUS$1,211higherthanits
counterpart (P= .026). By the same token, a patient who is a year older would
incur US$23 higher cost (P= .040). Having any structural problem in urinary
tract would incur US$1,231 higher cost (P= .015). A unit increase in Pitt score
would incur US$767 USD higher cost (P <0.001) higher cost, all other things
constant. Conclusions: Medical costs for hospitalized patients with CA-APN
are increased by the existence of ESBL-producing Enterobacterales but not by
the existence of ciprofloxacin-resistant Enterobacterales.
Funding: No
Disclosures: None
Antimicrobial Stewardship & Healthcare Epidemiology 2021;1(Suppl. S1):s23
doi:10.1017/ash.2021.42
Presentation Type:
Oral Presentation
Subject Category: Medical Informatics
Automated Nationwide Benchmarking Dashboard for Antimicrobial
Stewardship Programs within the Veterans’Health Administration
Michihiko Goto; Eli Perencevich; Alexandre Marra; Bruce Alexander; Brice Beck;
Daniel Livorsi; Julia Friberg; Christopher Richards; DeShauna Jones and
Michael Sauder
Group Name: VHA Center for Antimicrobial Stewardship and Prevention
of Antimicrobial Resistance (CASPAR) Background: Antimicrobial steward-
ship programs (ASPs) are advised to measure antimicrobial consumption as a
metric for audit and feedback. However, most ASPs lack the tools necessary
for appropriate risk adjustment and standardized data collection, which are criti-
cal for peer-program benchmarking. We created a system that automatically
extracts antimicrobial use data and patient-level factors for risk-adjustment
and a dashboard to present risk-adjusted benchmarking metrics for ASP within
the Veterans’Health Administration (VHA). Methods: We built a system to
extract patient-level data for antimicrobial use, procedures, demographics,
and comorbidities for acute inpatient and long-term care units at all VHA hos-
pitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline
negative binomial regression models to perform risk-adjustments based on
patient- and unit-level factors using records dated between October 2016 and
September 2018. These models were then leveraged both retrospectively and pro-
spectively to calculate observed-to-expected ratios of antimicrobial use for each
hospital and for specific units within each hospital. Data transformation and
applications of risk-adjustment models were automatically performed within
the CDW database server, followed by monthly scheduled data transfer from
the CDW to the Microsoft Power BI server for interactive data visualization.
Frontline antimicrobial stewards at 10 VHA hospitals participated in the project
as pilot users. Results: Separate baseline risk-adjustment models to predict days
of therapy (DOT) for all antibacterial agents were created for acute-care and long-
term care units based on 15,941,972 patient days and 3,011,788 DOT between
October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment mod-
els include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute
care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and
long-term care, respectively), and preceding procedures (45 and 24 procedures
for acute care and long-term care, respectively). We created additional models for
each antimicrobial category based on National Healthcare Safety Network def-
initions. For each hospital, risk-adjusted benchmarking metrics and a monthly
ranking within the VHA system were visualized and presented to end users
Figure 1.
SHEA Spring 2021 Abstracts
2021;1 Suppl 1 S23
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. This is an Open Access article, distributed under the
terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium,
provided the original work is properly cited.
through the dashboard (an example screenshot in Figure 1). Conclusions:
Developing an automated surveillance system for antimicrobial consumption
and risk-adjustment benchmarking using an electronic medical record data
warehouse is feasible and can potentially provide valuable tools for ASPs, espe-
cially at hospitals with no or limited local informatics expertise. Future efforts will
evaluate the effectiveness of dashboards in these settings.
Funding: No
Disclosures: None
Antimicrobial Stewardship & Healthcare Epidemiology 2021;1(Suppl. S1):s23–s24
doi:10.1017/ash.2021.43
Presentation Type:
Presentation Type: Oral Presentation
Subject Category: MRSA/VRE
Discontinuation of Contact Precautions in Patients with Nosocomial
MRSA and VRE Infections During the COVID-19 Pandemic
Marisa Hudson and Mayar Al Mohajer
Background: Gaps exist in the evidence supporting the benefits of con-
tact precautions for the prevention of methicillin-resistant
Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci
(VRE). The Centers for Disease Contro land Prevent ion allow suspending
contact precautions for MRSA and VRE in cases of gown shortages, as we
have seen during the COVID-19 pandemic. We evaluated the impact of
discontinuing isolation precautions in hospitalized patients with MRSA
and VRE infection, due to gown shortage, on the rate of hospital-acquired
(HA) MRSA and VRE infections. Methods: A retrospective chart review
was performed on adult patients (n = 2,200) with established MRSA or
VRE infection at 5 hospitals in CommonSpirit Health, Texas Division,
from March 2019 to October 2020. Data including demographics, infec-
tion site, documented symptoms, and antibiotic use were stratified based
on patient location (floor vs ICU). Rates of hospital-acquired MRSA and
VRE infection before and after the discontinuation of isolation (imple-
mented in March 2020) were compared. Incidence density rate was used
to assess differences in th e rate of MRSA and VRE infect ions between pre-
and postintervention groups. Results: The rate of hospital-acquired (HA )
MRSA infection per 10,000 patient days before the intervention (March
19–February 20) was 12.19, compared to 10.64 after the intervention
(March 20–July 20) (P= .038). The rates of HA MRSA bacteremia were
1.13 and 0.93 for the pre- and postintervention groups, respectively (P=
.074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for
the pre- and postintervention groups, respectively (P= .274). The hand
hygiene rates were 0.93 before the intervention and 0.97 after the inter-
vention (P= .028). Conclusions: Discontinuing isolation from MRSA
and VRE in the hospital setting did not lead to a statistically significant
increase in hospital-acquired MRSA or VRE infections. In fact, rates of
hospital-acquired MRSA decreased, likely secondary to improvements in
hand hygiene during this period. These results support the implementa-
tion of policies for discontinuing contact isolation for hospitalized
patients with documented MRSA or VRE infection, particularly during
shortages of gowns.
Funding: No
Disclosures: None
Antimicrobial Stewardship & Healthcare Epidemiology 2021;1(Suppl. S1):s24
doi:10.1017/ash.2021.44
Figure 1.
Figure 2.
Figure 3.
SHEA Spring 2021 Abstracts
S24 2021;1 Suppl 1
