Direct Hospitalization Costs Associated with Resistant and Susceptible

Antimicrobial-resistant enteric infections may be difficult to treat, associated with severe outcomes, and costly. To determine if resistant enteric infections are more costly, we described direct hospitalization costs for hospital admissions for typhoid fever, salmonellosis, and shigellosis infections by resistance status. We included all inpatient admissions with culture-confirmed infections from approximately 300 hospitals in the Premier Healthcare database during 2012-2019. We classified typhoid fever, salmonellosis, and shigellosis infections as clinically resistant if laboratory testing found resistance to ≥1 antibiotic class recommended for treatment. We examined patient demographic characteristics and underlying chronic conditions. We used the Wilcoxon rank sum test to assess the difference in median hospitalization cost for each patient admission by resistance status. We estimated adjusted cost and length of stay (LOS) using multivariable linear regression, adjusting for host and health care provider characteristics. Among 67 inpatient admissions for typhoid fever, 3421 for salmonellosis, and 619 for shigellosis, 33% of typhoid fever, 13% of salmonellosis, and 82% of shigellosis infections were clinically resistant. The unadjusted median costs for resistant salmonellosis were higher than susceptible infection-related costs ($7,753 vs. $6,909,