Economic and Clinical Impact of Ventilator-Associated Pneumonia in Intensive Care Units of a University Hospital Center

Rodrigues, Joana; Sousa, Paulo

doi:10.1007/978-3-030-24067-7_16

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…8 The findings from this study are also consistent with the findings of most previous studies, which found hospitalization expenses and antibiotic expenses in patients who had VAP to be higher than in patients without VAP. 17,18 Therefore, finding preventive measures is important. VAP prevention guidelines consist of the following three main guidelines:…”

Section: Discussionmentioning

confidence: 99%

Comparison Study between Using Disposable and Non-Disposable Ventilator Circuits on Ventilator-Associated Pneumonia and Health Care Costs at a Respiratory Care Unit, Siriraj Hospital

Songmuang

Akatat²,

Wattanagulanurak³

et al. 2023

Siriraj Med J

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Objective: This research aimed to compare the incidence of ventilator-associated pneumonia (VAP) and ventilator circuit costs among patients using disposable ventilator circuits and patients using non-disposable ventilator circuits. Materials and Methods: Observational research was performed consisting of the following: A retrospective chart review of a group of patients who used non-disposable circuits (n=193) and a prospective cohort study of a group of patients using disposable circuits (n=166). The sample was purposively selected based on the following inclusion criteria: patients aged 18 years old and over who were admitted to the Respiratory Care Unit, Siriraj Hospital and ventilated >48 h. Results: VAP incidence in the group non-disposable circuits was 10.41/1,000 ventilator days (n=27, 13.8%) and 10.82 /1,000 ventilator days (n=24, 14.4%) in the group disposable circuits (p=0.871). According to the data analysis using the U-control chart, no statistically significant differences were found. The unit cost of the non-disposable circuit was lower than that of the disposable circuit (THB 295.94), while the work unit personnel satisfaction toward working with disposable circuits was at a good level (Mean=3.83) and medium level (Mean=3.12) in non-disposable circuits (p=0.002). Conclusion: The type of ventilator circuits had no effects on VAP rate. The unit cost of non-disposable circuits was lower than that of disposable circuits, while the work unit personnel had a higher satisfaction working with disposable circuits than non-disposable circuits.

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Section: Discussionmentioning

confidence: 99%

Comparison Study between Using Disposable and Non-Disposable Ventilator Circuits on Ventilator-Associated Pneumonia and Health Care Costs at a Respiratory Care Unit, Siriraj Hospital

Songmuang

Akatat²,

Wattanagulanurak³

et al. 2023

Siriraj Med J

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“…Direct costs were obtained from national price lists and standardized costing methods for ICU stays. [39][40][41] Costs were adjusted to 2019 euros with country-specific healthcare price indices. 42 All analyses were performed in R version 3.6.2 software (2019).…”

Section: Statistical and Economic Analysesmentioning

confidence: 99%

Association between antibiotic resistance in intensive care unit (ICU)–acquired infections and excess resource utilization: Evidence from Spain, Italy, and Portugal

Serra-Burriel

Campillo-Artero

Agodi

et al. 2021

Infect. Control Hosp. Epidemiol.

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Background: Intensive care unit (ICU)–acquired infections with antibiotic-resistant bacteria have been associated with substantial health and economic costs. Moreover, southern Europe has historically reported high levels of antimicrobial resistance. Objectives: We estimated the attributable economic burden of ICU-acquired infections due to resistant bacteria based upon hospital excess length of stay (LOS) in a selected sample of southern European countries. Methods: We studied a cohort of adult patients admitted to the ICU who developed an ICU-acquired infection related to an invasive procedure in a sample of Spanish, Italian, and Portuguese hospitals between 2008 and 2016, using data from The European Surveillance System (TESSy) released by the European Centers for Disease Control (ECDC). We analyzed the association between infections with selected antibiotic-resistant bacteria of public health importance and excess LOS using regression, matching, and time-to-event methods. We controlled for several confounding factors as well as time-dependent biases. We also computed the associated economic burden of excess resource utilization for each selected country. Results: In total, 13,441 patients with at least 1 ICU-acquired infection were included in the analysis: 4,106 patients (30.5%) were infected with antimicrobial-resistant bacteria, whereas 9,335 patients (69.5%) were infected with susceptible bacteria. The unadjusted association between resistance status and excess LOS was 7 days (95% CI, 6.13–7.87; P < .001). Fully adjusted models yielded significantly lower estimates: 2.76 days (95% CI, 1.98–3.54; P < .001) in the regression model, 2.60 days (95% CI, 1.66–3.55; P < .001) in the genetic matching model, and a hazard ratio of 1.15 (95% CI, 1.11–1.19; P < .001) in the adjusted Cox regression model. These estimates, alongside the prevalence of resistance, translated into direct hospitalization attributable costs per ICU-acquired infection of 5,224€ (95% CI, 3,691–6,757) for Spain, 4,461€ (95% CI, 1,948–6,974) for Portugal, and 4,320€ (95% CI, 1,662–6,977) for Italy. Conclusions: ICU-acquired infections associated with antibiotic-resistant bacteria are substantially associated with a 15% increase in excess LOS and resource utilization in 3 southern European countries. However, failure to appropriately control for significant confounders inflates estimates by ∼2.5-fold.

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“…Studies have shown that mechanical ventilation increases from 7.6 days to 11.5 days, and hospital stay from 11.5 to 13.1 days in patients with VAP compared to patients without VAP. Longer hospital stay and ventilation incur an additional cost of approximately $40 000 per patient and has been associated with other complications such as respiratory failure, pleural effusion, and septic shock as well as mortality (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Prevalence incidence and clinical outcome of Klebsiella and Acinetobacter ventilator-associated pneumonia

et al. 2022

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Introduction: Antimicrobial resistance identification for each hospital has benefits in management of nosocomial infections. Objectives: The aim of this study was to determine antimicrobial susceptibility of meropenem against Acinetobacter and Klebsiella strains in samples obtained from hospitalized patients with ventilator-associated pneumonia (VAP). Patients and Methods: In this cross-sectional study, 100 patients with VAP were selected from the intensive care unit (ICU) of Amin hospital in Isfahan. Lung secretions were collected and tested for bacterial infections. In samples with the positive bacterial infection, E-test and agar diffusion test were used to determine and compare the susceptibility of Acinetobacter and Klebsiella strains to meropenem. Results: The two susceptibility testing methods – E-test and agar diffusion test – showed similar results in 87 cases (87%) therefore, 84 cases were resistant and three cases were susceptible to meropenem. However, in 13 cases, the result of the agar diffusion test was resistant and the result of E-test was sensitive. According to the Kappa test, the agreement between the two tests was 0.87 and statistically significant (P <0.001). Conclusion: Due to the high resistance of Klebsiella and Acinetobacter strains to meropenem, it should not be used as an experimental treatment in patients diagnosed with VAP caused by these strains. We recommend using meropenem for Acinetobacter and Klebsiella after susceptibility testing by E-test confirmed its efficacy.

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Economic and Clinical Impact of Ventilator-Associated Pneumonia in Intensive Care Units of a University Hospital Center

Cited by 3 publications

References 11 publications

Comparison Study between Using Disposable and Non-Disposable Ventilator Circuits on Ventilator-Associated Pneumonia and Health Care Costs at a Respiratory Care Unit, Siriraj Hospital

Comparison Study between Using Disposable and Non-Disposable Ventilator Circuits on Ventilator-Associated Pneumonia and Health Care Costs at a Respiratory Care Unit, Siriraj Hospital

Association between antibiotic resistance in intensive care unit (ICU)–acquired infections and excess resource utilization: Evidence from Spain, Italy, and Portugal

Prevalence incidence and clinical outcome of Klebsiella and Acinetobacter ventilator-associated pneumonia

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