Abstract
Purpose
Central venous catheter-associated bloodstream infections (CVC BSI) are a common and serious complication among critically ill patients on intensive care units (ICUs), but also result in a financial burden for the health care system. Our aim was to determine the additional costs and length of stay (LOS) of patients with ICU-acquired CVC BSI.
Methods
We used the surveillance method of the German nosocomial infection surveillance system (Krankenhaus Infections Surveillance System, KISS) to find cases of CVC BSI. The associated costs of CVC BSI were estimated as true costs generated within our hospital. We used a matched cohort design, comparing patients with CVC BSI and patients without BSI. The study period was from January to December 2010. Patients were matched by age, sex, and Simplified Acute Physiology Score (SAPS). The LOS in the ICU of control patients needed to be at least as long as that of CVC BSI patients before the onset of CVC BSI.
Results
We matched 40 CVC BSI patients to 40 patients without BSI. The median hospital costs for CVC BSI patients were significantly higher than for patients without BSI (60,445 € vs. 35,730 €; p = 0.006) and the CVC BSI patients stayed longer in the hospital than patients without CVC BSI (44 days vs. 30 days; p = 0.110). The median attributable costs per CVC BSI was 29,909 € (p = 0.006) and the median attributable LOS was 7 days (p = 0.006).
Conclusion
CVC BSI is associated with increased hospital costs and prolonged hospital stay. Hospital management should implement control measurements to keep the incidence of CVC BSI as low as possible.
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References
Rosenthal VD, Maki DG, Graves N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control. 2008;36:e1–12. doi:10.1016/j.ajic.2008.06.003.
Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41:1591–8. doi:10.1086/497833.
Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med. 2006;34:2084–9. doi:10.1097/01.CCM.0000227648.15804.2D.
Pirson M, Dramaix M, Struelens M, Riley TV, Leclercq P. Costs associated with hospital-acquired bacteraemia in a Belgian hospital. J Hosp Infect. 2005;59:33–40. doi:10.1016/j.jhin.2004.07.006.
Pirson M, Leclercq P, Jackson T, Leclercq M, Garrino M, Sion C. Financial consequences of hospital-acquired bacteraemia in three Belgian hospitals in 2003 and 2004. J Hosp Infect. 2008;68:9–16. doi:10.1016/j.jhin.2007.10.006.
Vrijens F, Hulstaert F, Van de Sande S, Devriese S, Morales I, Parmentier Y. Hospital-acquired, laboratory-confirmed bloodstream infections: linking national surveillance data to clinical and financial hospital data to estimate increased length of stay and healthcare costs. J Hosp Infect. 2010;75:158–62. doi:10.1016/j.jhin.2009.12.006.
Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med. 1999;160:976–81.
Higuera F, Rangel-Frausto MS, Rosenthal VD, Soto JM, Castañon J, Franco G, et al. Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol. 2007;28:31–5. doi:10.1086/510812.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271:1598–601.
Zuschneid I, Rücker G, Schoop R, Beyersmann J, Schumacher M, Geffers C, et al. Representativeness of the surveillance data in the intensive care unit component of the German nosocomial infections surveillance system. Infect Control Hosp Epidemiol. 2010;31:934–8. doi:10.1086/655462.
Gastmeier P, Geffers C, Sohr D, Dettenkofer M, Daschner F, Rüden H. Five years working with the German nosocomial infection surveillance system (Krankenhaus Infektions Surveillance System). Am J Infect Control. 2003;31:316–21. doi:10.1067/mic.2003.66.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32. doi:10.1016/j.ajic.2008.03.002.
Krause R, Valentin T, Salzer H, Hönigl M, Valentin A, Auner H, et al. Which lumen is the source of catheter-related bloodstream infection in patients with multi-lumen central venous catheters? Infection. 2013;41:49–52.
van der Kooi TI, Wille JC, van Benthem BH. Catheter application, insertion vein and length of ICU stay prior to insertion affect the risk of catheter-related bloodstream infection. J Hosp Infect. 2012;80:238–44. doi:10.1016/j.jhin.2011.11.012.
Graves N, Barnett AG, Halton K, Crnich C, Cooper B, Beyersmann J, et al. The importance of good data, analysis, and interpretation for showing the economics of reducing healthcare-associated infection. Infect Control Hosp Epidemiol. 2011;32:927–8. doi:10.1086/661600 (author reply 8–30).
Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P. Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect. 2009;72:97–103. doi:10.1016/j.jhin.2008.12.012.
Eber MR, Laxminarayan R, Perencevich EN, Malani A. Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Arch Intern Med. 2010;170:347–53. doi:10.1001/archinternmed.2009.509.
Rosenthal VD, Guzman S, Migone O, Crnich CJ. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control. 2003;31:475–80. doi:10.1016/j.ajic.2003.03.002.
Orsi GB, Di Stefano L, Noah N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol. 2002;23:190–7. doi:10.1086/502034.
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Leistner, R., Hirsemann, E., Bloch, A. et al. Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): a matched prospective cohort study. Infection 42, 31–36 (2014). https://doi.org/10.1007/s15010-013-0494-z
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DOI: https://doi.org/10.1007/s15010-013-0494-z