Hospital-Acquired, Laboratory-Confirmed Bloodstream Infection: Increased Hospital Stay and Direct Costs

Abstract

Orsi, GB; di Stefano, L; Noah, N (2002) HOSPITAL-ACQUIRED, LABORATORY-CONFIRMED BLOODSTREAM INFECTION: INCREASED HOSPITAL STAY AND DIRECT COSTSGiovanni Battista Orsi, MD; Lidia Di Stefano, MD; Norman Noah, MB, FRCP OBJECTIVES:To determine increased hospital stay and direct costs attributable to hospital-acquired, laboratory-confirmed bloodstream infection (BSI), and to evaluate the matching variable length of stay (LOS).DESIGN: Retrospective (historical) cohort study with 1:2 matching in intensive care units and surgical wards.SETTING: A 2,000-bed university hospital in Rome, Italy. PATIENTS: All patients admitted between January 1994 and June 1995 who had hospital-acquired, laboratory-confirmed BSI were considered cases; all others were eligible as controls.METHODS: Two controls (A and B) were selected per case in a stepwise fashion. Controls in group A were selected according to the following six criteria: ward, gender, age, diagnosis, central venous catheter, and LOS equal to the interval from admission to infection in a matched case ± 20% (LOS ± 20%). Controls in group B were selected according to the first five criteria, but excluded LOS ± 20%.RESULTS: One hundred five of 108 patients were each matched with two controls. The matching appropriateness score was greater than 90%. With the use of controls in groups A and B, the case-fatality rates attributable to hospital-acquired, laboratoryconfirmed BSI were 35.2% and 40.9%, respectively; the estimated risk ratios for death were 2.60 and 3.52 (P = .0001), respectively. The increased hospital stay per case attributable to hospitalacquired, laboratory-confirmed BSI was 19.1 (mean) and 13.0 (median) days for matched pairs in control group A and 19.9 (mean) and 15.0 (median) days for matched pairs in control group B. With controls in group A, the cost of increased hospital stay per patient attributable to hospital-acquired, laboratory-confirmed BSI was Euro 15,413. The additional cost per patient due to treatment was Euro 943, making the overall direct cost Euro 16,356 per case.CONCLUSIONS: This study should make it possible to estimate the cost of hospital-acquired, laboratory-confirmed BSI in most hospitals after adjusting for incidence rate. It also confirmed the use of LOS ± 20% as a matching variable to limit overestimation of increased hospital stay. To our knowledge, this is among the first such studies in Europe (Infect Control Hosp Epidemiol 2002;23:190-197).Hospital-acquired, laborator y-confirmed bloodstream infection (BSI) is an important cause of morbidity and mortality, adding significantly to the economic burden of hospitals. [1][2][3][4][5] There are costs with all hospital infections. The direct costs are represented principally by increased hospital stay, drug treatment, and medical and surgical procedures. Indirect costs include the patient's lost salary, relatives' time, and infirmity. Because it is difficult to evaluate all variables exactly, especially indirect costs, investigators generally estimate only direct additional costs and, par...

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