# Direct economic costs related to antimicrobial resistance in bloodstream infections isolated from newborns in a perinatal hospital in Peru

## TL;DR

This study estimates the economic costs of antimicrobial resistance in newborn bloodstream infections at a hospital in Peru, showing higher costs for drug-resistant bacteria.

## Contribution

The study provides the first direct economic cost analysis of AMR in neonatal bloodstream infections in a low/middle-income country.

## Key findings

- Multidrug-resistant strains cost an average of US$349 per case, compared to US$276 for non-MDR strains.
- Late-onset sepsis, multidrug resistance, and age were significantly associated with higher bloodstream infection costs.
- Acinetobacter had the highest average costs among microorganisms, followed by Pseudomonas.

## Abstract

Antimicrobial resistance (AMR) has emerged as a priority for both public health and the global economy. Moreover, information on AMR is scarce, particularly in low/middle-income countries. We evaluated the direct economic cost of microorganisms and AMR.

We performed a cross-sectional study to assess the economic costs of neonatal cases diagnosed with bacteremia at the Instituto Nacional Materno Perinatal in Lima, Peru, from January 2017 to June 2018. We used cost invoices calculated by the micro-costing bottom-up approach, as well as the strain identification and antimicrobial susceptibility data, to estimate the direct costs.

The average costs of bacteremia were US$349 (SD 403) for multidrug-resistant (MDR) strains and US$276 (SD 349) for non-MDR strains. Costs were higher for microorganisms associated with late-onset sepsis (LOS). We found that LOS, multidrug resistance and age were significantly associated with bloodstream infection (BSI) costs. Also, all microorganism groups were associated with increased costs, with the highest average costs for Acinetobacter, followed by Pseudomonas.

In Peru, BSI costs are strongly associated with AMR. Furthermore, costs increase significantly with LOS, multidrug resistance and the patient's age. We urge health authorities to strengthen measures and strategies against the pressing threat of AMR.