Abstract
Background
Healthcare-associated infections (HAIs) are frequent in intensive care units (ICUs) and are associated with substantial clinical and economic burden. However, the independent contribution of antimicrobial resistance (AMR) beyond the occurrence of infection remains uncertain.Methods
We conducted a retrospective cohort study including 802 adult ICU admissions in a tertiary university hospital. Patients were classified into three groups: no ICU-acquired HAI (n=666), HAI without AMR (n=105), and HAI with AMR (n=31). Primary outcomes were ICU length of stay (LOS) and hospital costs; hospital mortality was analysed as a secondary outcome. Generalized linear models adjusted for age, sex, Simplified Acute Physiology Score II (SAPS II), and comorbidities were used. A restricted analysis among infected patients evaluated the independent association of AMR.Results
ICU-acquired HAI occurred in 17% of patients, with AMR identified in 3.9%. ICU LOS increased across groups (6 vs 19 vs 21 days; pConclusions
ICU-acquired infection was the primary driver of increased ICU length of stay and hospital costs. After adjustment for severity and comorbidity burden, antimicrobial resistance was not independently associated with additional resource utilization among infected patients. These findings highlight infection prevention as a priority for reducing ICU burden, alongside antimicrobial stewardship strategies.