Hospital-associated infection cost analysis
Abstract:
Introduction: Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length-of-stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, were carried out in a small number of centres, or only in high-income countries.
Methods: We carried out a prospective cohort study in ten Brazilian intensive care units (ICUs) selected from a collaborative platform study (IMPACTO MR). We included all patients aged 18 years or older admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. We used a propensity score matching method to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CA-UTI) and multidrug-resistant (MDR) HAIs.
Results: We included 7,953 patients in the study, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity-score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs [$ 19,642 (IQR; 12,884-35,134) vs. 6,086 (IQR; 3,268-12,550); p <0.001). Patients with VAP, CLABSI, and CA-UTI, but not with MDR-HAIs also had higher total ICU costs.
Conclusions: HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.
Reference:
Bezerra IL, Nassar Junior AP, Dos Santos TM, Tomazini BM, Veiga VC, Arns B, Nascimento GM, Cavalcanti AB, Malheiro DT, Pereira AJ; IMPACTO MR Investigators. Patient-level cost analysis of intensive care unit acquired infections: A prospective cohort study. J Hosp Infect. 2024 Jul 18:S0195-6701(24)00251-2. doi: 10.1016/j.jhin.2024.07.002. Epub ahead of print. PMID: 39032569.