The Attributable Mortality and Costs of Primary  Nosocomial Bloodstream Infections in the Intensive Care Unit

DiGiovine, Bruno; Chenoweth, Carol E.; Watts, Charles M.; Higgins, Millicent

doi:10.1164/ajrccm.160.3.9808145

Cited by 397 publications

(220 citation statements)

References 24 publications

Supporting

Mentioning

191

Contrasting

Unclassified

Order By: Relevance

“…However, because it assumes that any difference in LOS is attributable to infection and not related to other inherent differences between the patient groups, it is generally considered to overestimate slightly the attributable days and costs. 4,6,7,10,11,13,15,16 Even with close matching (1:1), case-control studies may have serious biases. 14 One is the difficulty of selecting and measuring all appropriate matching variables to eliminate all confounding factors and obtain suitable controls from the uninfected patient pool.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Studies performed to estimate increased hospital stay and related costs attributable to hospital-acquired, laboratory-confirmed BSI report results ranging from 7 to 30 days, 2,7-13 depending principally on microorganisms 9,13 and type of ward (eg, intensive care unit [ICU]). 7,10,11 The related costs range from $3,061 to $40,000. 2 Most of these were case-control studies.…”

mentioning

confidence: 99%

“…4,6,7,10,[13][14][15][16] To improve matching, some investigators introduced a scoring system that measures precisely the matching appropriateness of controls and, to avoid overestimating the length of hospitalization, an important matching criterion that stipulates the "length of stay in controls equal to the interval from admission to infection in cases ± 10%" (LOS ± 10%). 10 Although the scoring system is undoubtedly useful, the LOS ± 10% criterion might itself be a confounding factor because it directly affects the LOS in controls and could lead to overmatching.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Orsi

Stefano

Noah

2002

Infect. Control Hosp. Epidemiol.

146

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Orsi

Stefano

Noah

2002

Infect. Control Hosp. Epidemiol.

146

View full text Add to dashboard Cite

show abstract

“…Un número creciente de estudios plantea que las infecciones del torrente sanguíneo son uno de los tipos de infección cuya atención demanda más recursos económicos (10)(11)(12)(13), lo que subraya la necesidad de conocer las implicaciones econó-micas de este fenómeno en nuestro medio, especialmente las relacionadas con S. aureus resistente a la meticilina (SARM).…”

unclassified

Impacto económico de la resistencia a meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

et al. 2014

View full text Add to dashboard Cite

“…Mortality rate attributed to its use is of 12%-25%, extending hospitalization by additional 10-40 days [4] which adds costs to the treatment about $33,000-35,000/ patient [5].…”

mentioning

confidence: 99%

Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery

Brito¹,

Gondim²,

Filho³

et al. 2007

Braz J Infect Dis

View full text Add to dashboard Cite

CVC is the main factor of risk of bloodstream infections. This study purpose was determining both etiology and pathogenesis of these infections in 80 patients who undergone gastrointestinal surgery and who worn long lasting CVC, in the institution HC-UFU. Cultures were made in nostril, skin of the insertion site, tip and catheter hub, in addition to hemoculture in those suspects of sepsis. The colonization incidence rate of the catheter tip was 12.5/ 1,000 catheter days and the CVC associate infection rate was 3.1/1,000 catheter days. Frequencies of skin, hub and catheter tip colonization were 13.8%, 8.9% and 13.3%, respectively. Coagulase-negative Staphylococci were the most found microorganisms in nostril (74%), skin (45.4%) and hub (75%) and Gram-negative bacilli (50%), followed by S. aureus (25%) the most common ones in catheter tip. Approximately 51% of patients received antibiotics and most of them (53.7%) had therapeutic purpose. The frequency of patients with clinical sepsis was 27.5%. Three cases of bacteremia associated with the use of CVC were detected (3.8%), with S. aureus in two of them and K. pneumoniae in the third one. There was not seen any association of skin and hub colonization with their presence in the catheter tip and in the blood of these patients, but S. aureus was recovered from nostril of those with sepsis by this pathogenic agent. A greater concern is suggested over preventive measures and control of these primary and secondary bloodstream, as well as catheter tip colonization.

show abstract

The Attributable Mortality and Costs of Primary Nosocomial Bloodstream Infections in the Intensive Care Unit

Cited by 397 publications

References 24 publications

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

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

Impacto económico de la resistencia a meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery

Contact Info

Product

Resources

About