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

Published online by Cambridge University Press:  02 January 2015

Giovanni Battista Orsi ,
Lidia Di Stefano  and
Norman Noah
Giovanni Battista Orsi*
Affiliation:
Institute of Hygiene, University “La Sapienza” Rome, Rome, Italy
Lidia Di Stefano
Affiliation:
Institute of Hygiene, University “La Sapienza” Rome, Rome, Italy
Norman Noah
Affiliation:
London School of Hygiene & Tropical Medicine, London, United Kingdom
*
Istituto di Igiene, Università “La Sapienza” Roma, Ple Aldo Moro 5, 00185 Roma, Italy
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Abstract

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, laboratory-confirmed 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 hospital-acquired, 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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 4 , April 2002 , pp. 190 - 197
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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