In a recently issued report, the Centers for Disease Control and Prevention (CDC) estimated the national burden of illnesses and deaths caused by the most common and most worrisome antibiotic-resistant pathogens.1 The report focused on 16 antimicrobial-resistant bacterial pathogens, as well as Candida infections, which together account for more than 2 million illnesses and at least 23,000 deaths every year in the United States.1 The report also included information on Clostridium difficile infections, which, like antibiotic resistance, are driven by antibiotic use. C. difficile causes more than 250,000 clinical infections annually and is associated with more than 14,000 deaths every year in the United States.1 | In this report, the CDC categorized 18 pathogens (eTable A) into three groups (urgent, serious, and concerning) based on seven criteria: clinical impact, economic impact, incidence, 10-year projection of incidence, transmissibility, availability of effective antibiotics, and barriers to prevention.1 Three types of bacteria were included in the urgent category: carbapenem-resistant Enterobacteriaceae, drug-resistant Neisseria gonorrhoeae, and C. difficile. In the past, drug-resistant strains of Enterobacteriaceae and N. gonorrhoeae have shown a propensity to spread rapidly in the United States and around the world. Some strains of carbapenem-resistant Enterobacteriaceae are currently untreatable with available antibiotics, and the cephalosporin agents to which some gonococci are now showing emerging resistance are the last available drugs to effectively treat this infection. Thus, further spread of these strains constitutes a public health crisis. C. difficile infections already cause significant morbidity and mortality, and a recently emerging epidemic strain, BI/NAP1/027, appears to be more virulent.

The prevention of central line-associated bloodstream infections in patients in hospital critical care units has been a target of efforts by the Centers for Disease Control and Prevention (CDC) since the 1960s. We developed a historical economic model to measure the net economic benefits of preventing these infections in Medicare and Medicaid patients in critical care units for the period 1990-2008-a time when reductions attributable to federal investment resulted primarily from CDC efforts-using the cost perspective of the federal government as a third-party payer. The estimated net economic benefits ranged from $640 million to $1.8 billion, with the corresponding net benefits per case averted ranging from $15,780 to $24,391. The per dollar rate of return on the CDC's investments ranged from $3.88 to $23.85. These findings suggest that investments in CDC programs targeting other health care-associated infections also have the potential to produce savings by lowering Medicare and Medicaid reimbursements.

BACKGROUND: Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) and conduct a sensitivity analysis comparing analytic methods. METHODS: A random sample of high-risk adults hospitalized in the year 2000 was selected. Measurements included total and variable medical costs, length of stay (LOS), HAI site, APACHE III score, antimicrobial resistance, and mortality. Medical costs were measured from the hospital perspective. Analytic methods included ordinary least squares linear regression and median quantile regression, Winsorizing, propensity score case matching, attributable LOS multiplied by mean daily cost, semi-log transformation, and generalized linear modeling. Three-state proportional hazards modeling was also used for LOS estimation. Attributable mortality was estimated using logistic regression. RESULTS: Among 1253 patients, 159 (12.7%) developed HAI. Using different methods, attributable total costs ranged between $9,310 to $21,013, variable costs were $1,581 to $6824, LOS was 5.9 to 9.6 days, and attributable mortality was 6.1%. The semi-log transformation regression indicated that HAI doubles hospital cost. The totals for 159 patients were $1.48 to $3.34 million in medical cost and $5.27 million for premature death. Excess LOS totaled 844 to 1373 hospital days. CONCLUSIONS: Costs for HAI were considerable from hospital and societal perspectives. This suggests that HAI prevention expenditures would be balanced by savings in medical costs, lives saved and available hospital days that could be used by overcrowded hospitals to enhance available services. Our results obtained by applying different economic methods to a single detailed dataset may inform future cost analyses.