Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs

Abstract

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients >13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p<0.01), yielding an excess hospital stay among cases of 32.1 days. The excess mortality among cases compared to controls that was attributable to S. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p<0.01). The cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. Healthcare-associated S. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential.

Validation of a Turkish translation of The Hand Hygiene Questionnaire

“…Health care-associated infection increases patient morbidity, mortality and health care costs. For example, a matched case-control study of the outcomes of bloodstream-associated Staphylococcus aureus infection demonstrated an excess length of stay of 32 days, a 7-fold increased risk of dying and health care costs around 3 times higher than for noninfected patients (1). One of the steps in the transmission of pathogens from health care workers' hands to patients is inadequate hand antisepsis (2).…”

Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin

“…nfections due to Staphylococcus aureus are a major public health concern and contribute to significant patient morbidity and mortality (1)(2)(3). Common infections include bacteremia, bone and joint infections, pneumonia, and infective endocarditis, which require long-term treatment.…”

Impacto de la infección nosocomial en un hospital de Bogotá (Colombia): efectos en mortalidad y costos

“…Los estudios realizados para evaluar el impacto de las IAAS han encontrado datos variables respecto a la mortalidad atribuible según el tipo de IAAS y el microorganismo causal. El estudio realizado por M. Borges en Brasil, encontró una mortalidad atribuible de 45% a las bacteriemias por Staphylococcus aureus 8 . Laupland K, en su estudio de bacteriemias en Canadá documentó una mortalidad atribuible de 16% 3 .…”

“…Los costos atribuibles por tipo de infección fueron similares a los reportados por las UCI de Canadá (US$ 12.321, 20% mayor) 3 y Bélgica (US$ 17.836, 15% menor) 14 en el caso de bacteriemias, menor a la reportada por bacteriemia por S. aureus (US$ 82.818, 81% menor) 8 , mayor a la reportada por bacteriemia por A. baumannii multiresistente (US$ 3.758, 75% mayor) 6 y menor a la atribuible a NAVM (US$ 11.897 10 , US$ 11.100 1 , 90% menor) posiblemente porque en el estudio este no fue el único tipo de neumonía incluido. Respecto al costo atribuible a ISQ, los costos fueron mayores que los reportados en la literatura (US$ 2.200 1 , US$ 3.740,58 13 , 72% y 53% mayor, respectivamente).…”