Length of stay and charges associated with health care-acquired bloodstream infections

Faculty of Nursing, AL AL-Bayt University, Mafraq, Jordan.
American journal of infection control (Impact Factor: 2.21). 05/2011; 40(3):227-32. DOI: 10.1016/j.ajic.2011.03.014
Source: PubMed


Although many studies have examined outcomes of health care-associated bloodstream infections (HCABSIs), population-based estimates of length of stay (LOS) and costs have seldom been reported.
Our objective was to generate US national estimates of LOS and costs associated with HCABSIs using the 2003 National Inpatient Sample (NIS).
This study utilized a matched case-control design to estimate LOS and costs associated with HCABSIs based on the 2003 (NIS). A special set of ICD-9-CM codes was used to identify cases. A 1:1 matching procedure was used in which HCABSIs in patients were matched with uninfected patients based on age, sex, and admission diagnosis. We performed weighted analysis to construct population estimates and their standard deviations for LOS and total charges.
After applying the case finding criteria, 113,436 HCABSI cases were identified. The weighted mean LOS for HCABSIs cases was 16.0 days compared with 5.4 days for the control group (P < .001). The weighted mean total charges for patients with HCABSIs were $85,813 ($110,183 US in 2010) compared with $22,821 ($29,302 US in 2010) for uninfected patients (P < .001). We estimated that, in 2003, HCABSIs potentially cost the US economy nearly $29 billion ($37.24 billion US in 2010).
This study estimated the economic burden of HCABSIs on the US national economy. With some modifications, the annually published NIS data could be useful as a national surveillance tool for health care adverse events including HCABSIs.

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Available from: Omar M. AL-Rawajfah, Dec 17, 2014
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    • "Recent U.S. data [15] suggested that in 2003 HCABSIs potentially cost the U.S. economy approximately $29 billion (37.24 billion in 2010 $US). This study [15] also suggested that HCABSIs result in approximately 8.5 extra hospitalization days for affected patients compared to uninfected patients. "
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    ABSTRACT: Few studies have been conducted in Jordan related to health care associated bloodstream infections (HCABSIs). This study aims to examine epidemiology of HCABSIs among hospitalized adult patients in Jordan. A cohort study (N=570; 445 confirmed HCABSIs, 125 uninfected patients) with a nested 1:1 matched case-control design (n=125 in each group) was used based on data from one large referral hospital in Jordan over a period of 5 years. HCABSI cases were determined based on confirmed positive blood culture after 48h of admission. The case-control analyses (n=250 per group) matched on gender, age, same admission month and unit. The overall incidence and mortality rates were 8.1 and 5.8 per 1000 admissions, respectively. Four-variable and three-variable multivariate models were proposed to explain the risk of HCABSIs in the matched analyses .The four-variable model consists of blood product (OR=24.5), invasive procedures (OR=4.3), renal failure (OR=9.2), and presence of other infections (OR=21.6). The three-variable model consists of recipient of blood product (OR=19.7), invasive procedures (OR=4.5), and renal failure (OR=9.4). This study is a pioneer study that examined risk factors, the associated HCABSIs in Jordan. Results from this study can be used to influence infection control plans in Jordan.
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    ABSTRACT: To evaluate laboratory confirmed bloodstream infection (LC-BSI) aetiology we carried out a prospective study in the general 13 bed ICU of the teaching hospital Policlinico Umberto I in Rome. According to CDC case definitions for LC-BSI, all patients admitted >48h between 2000-2007 to ICU were included. Risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 1741 patients (64.8% males, 35.2% females) were included, mean age was 58.1 +/- 19.8, SAPS II score 45.1 +/- 17 and ICU stay 14.0 +/- 21.1 days. Finally, 167 (9.6%) patients developed 203 (11.7%) ICU-acquired LC-BSI and sources of infection were CVC (39.8%), unknown (39.3%), respiratory tract (12.4%), surgical wound (6.5%) and urinary tract (2.0%). Between 2000 and 2007 the incidence of LC-BSI/1000 patient days (14.8 per thousands vs. 7.8 per thousands: p<0.05) and LC-BSI/1000 CVC days (20.7 per thousands vs. 11.4 per thousands; p<0.05) decreased. The onset of infection followed ICU admission by 19.5 +/- 17.7 (mean) and 13 days (median). Crude mortality was 34.8%, and mortality associated with LC-BSI showed a RR 1.61; 95%CI 1.37 - 1.89; p<0.01. The most common pathogens were coagulase negative staphylococci (CNS) (26.2%), methicillin-resistant Staphylococcus aureus (MRSA) (14.9%), Pseudomonas aeruginosa (13.5%), enterococci (9.3%) and Acinetobacter bawnumannii (7.5%). Onset time (days) between ICU admission and LC-BSI was higher (p<0.01) among Gram-negative (22.9 +/- 18.4) compared to Gram-positive (16.6 +/- 15.9), fungi (23.8 +/- 25.3). High early death (<7 days after BSI diagnosis) was associated to A. baumannii (37.5%), Candida spp. (30.0%) and S. aureus (29.7%). Staphylococci presented a very high methicillin resistance (>85%). P. aeruginosa and A. baumannii showed respectively 25% and 68.7% multidrug-resistance. Over 1/3 of Eneterobacteriaceae isolates were extended spectrum beta-lactamase (ESBL), but non resulted resistant to carbapenems. Surveillance showed a high incidence of LC-BSI associated to invasive procedures and the presence of multiresistant bacteria.
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    ABSTRACT: Background: No studies have been carried out in Jordan to examine length of stay (LOS) and extra cost associated with health care-associated bloodstream infections (HCABSIs). This study aims to estimate the extra LOS and cost associated with HCABSIs among adult hospitalized Jordanian patients. Methods: Five-year data were retrieved from 1 large university-affiliated hospital in Jordan. Matched case-control design was used in this study. Cases were determined based on confirmed positive blood culture after 48 hours of admission. Matching criteria were age (±5 years), gender, admission diagnosis, and LOS in comparison group equal to the LOS (±5%) before blood culture for the case group. Results: Of the total 445 infected patients 125 (28.1%) were matched with uninfected patients. The mean LOS after infection for cases was 12.1 days (standard deviation [SD] = 17.2) compared with 8.3 (SD = 7.9) days for the controls (P = .02). The total mean inflation-adjusted charges for cases was M (mean) = US $7,426, SD = $7,252 compared with M = $3,274, SD = $4,209 for controls, P < .001. Using multiple regression modeling, LOS after acquiring HCABSIs, admission to critical care units, and being infected with HCABSIs were significant predictors of patients' total charges. Conclusion: Figures generated from this can be used to inform health care researchers, policy makers, and professionals about the impact of HCABSIs.
    No preview · Article · Jan 2013 · American journal of infection control
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