OBJECTIVES: Multidrug resistant (MDR) bacterial infections in hospital settings have substantial implications in terms of clinical and economic outcomes. However, due to the heterogeneity in resistance patterns, findings about the relationships between MDR infections and economic or clinical outcomes are currently under debate. We performed a systematic review and meta-analysis on the impact of MDR on clinical and economic outcomes, considering differences in the specific application, study design, and methodology.

METHODS: A literature search was conducted in PubMed/MEDLINE library database to select studies that evaluated the impact of antimicrobial resistance on economic and clinical outcomes, published in between 1980 and 2018. Next, a meta-analysis was performed to establish the adjusted association of MDR hospital acquired infection (HAI) with direct cost of care, prolonged length of stay and mortality.

RESULTS: Overall, 23 articles were included in the systematic review of which 12 articles assessed cost, 13 articles assessed length of stay, and 12 assessed mortality. The pooled mean ratios with 95% confidence intervals (95%CI) were 1.55 (95%CI=1.49; 1.62) for direct cost of care was and 1.23 (95%CI=1.20; 1.27) for length of stay, respectively. The hazard rate for mortality was 2.27 (95%CI=2.13; 2.41). Statistical and methodological heterogeneity among the included studies was found to be present.

CONCLUSIONS: MDR HAI appears to be strongly associated with increases in direct cost, prolonged length of stay and increased mortality. Further comprehensive studies in this setting are warranted.