Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

Abstract

Objective: Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery. Design: Retrospective case-control study. Setting: Four academic medical centers. Patients: Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries. Methods: Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0. Results: Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719). Conclusions: Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries

“…Although there are international recommendations for SSI prevention, it can be challenging to implement them in various clinical settings, especially in LMICs, because of a lack of resources and an unorganized infrastructure [ 42 ]. This section highlights the differences in patient outcomes between high-, medium-, and low-income nations (Table 2 ).…”

“…Both qualitative and quantitative measures were analyzed, mainly using SF-36 questionnaires. According to the findings of the few studies, SSI has a considerable negative influence on patients' QoL and impacts their physical, psycho-social, and financial well-being, as well as the doctorpatient connection [40][41][42][43][44][45][46][47]. A nested case-control study at the University of Iowa Hospitals and Clinics revealed that factors like LOS before surgery and postoperative cerebrospinal fluid leak increase the risk of SSIs.…”

“…Although there are international recommendations for SSI prevention, it can be challenging to implement them in various clinical settings, especially in LMICs because of a lack of resources and an unorganized infrastructure [42][43][44][45][46][47][48][49][50][51][52].…”

Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients

“…In its 2014 report, the National Healthcare Safety Network reported that most bloodstream infections (63.0%) and access-related bloodstream infections (69.8%) occurred in hemodialysis patients with a CVC (5). The cost of ambulatory care of CRBSI, and hospitalization of pediatric hemodialysis patients with CRBSI is substantial, ranging between $11,584-36,266 per patient, with higher costs in patients needing intensive care unit stay and CVC replacement (6,7). Microbial colonization and biofilm formation on the surface of CVC occurs frequently in hemodialysis patients dialyzed through CVC, and has been identified as a source of the microorganisms causing CRBSI (8)(9)(10)(11).…”

Pediatric surgical site infection (SSI) following ambulatory surgery: Incidence, risk factors and patient outcomes

“…19 Despite unclear rates, data from the database used in this study indicated that costs of SSI following ambulatory surgery in pediatric patients were $6,370 per infection (95% confidence interval [CI], $4,022-$8,719). 20 Rates of SSI following pediatric ambulatory surgery in all surgery types and in a multicenter cohort have never been clarified, and risk factors for this type of infection as well as outcomes remain unclear. To fill this knowledge gap, we conducted a multi-institution retrospective epidemiologic study to identify and analyze incidence, risk factors, and outcomes associated with SSIs following all types of ambulatory surgery in pediatric patients.…”