Major article
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☆

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Abstract

Background

Limited information is available on the financial impact of central venous catheter-associated bloodstream infection (BSI) in Argentina. To calculate the cost of BSIs in the intensive care department (ICU), a 5-year prospective nested case-control study was undertaken at 3 hospitals in Argentina.

Methods

We studied 6 adult ICUs from 3 hospitals. In all, 142 patients with BSI and 142 control patients without BSI were matched for hospital, type of ICU, year of admission, length of stay, sex, age, and average severity of illness score. Patients' length of stay in the ICU was obtained prospectively on daily rounds. The hospitals' finance departments provided the cost of each ICU day. The hospitals' pharmacies provided the cost of antibiotics prescribed for BSIs.

Results

The mean extra length of stay for patients with BSI compared with control patients was 11.9 days, the mean extra antibiotic defined daily dose was 22.6, the mean extra antibiotic cost was $1913, the mean extra cost was $4888.42, and the excess mortality was 24.6%.

Conclusions

In this study, patients with central venous catheter-associated BSI experienced significant prolongation of hospitalization, increased use of health care costs, and a higher attributable mortality. These findings support the need to implement preventative interventions for patients hospitalized with central venous catheters in Argentina.

Section snippets

Setting

The study was conducted in 3 medical centers in Buenos Aires, Argentina. Each center has an infection control team comprised of an internal medicine doctor with a formal education in infectious diseases and hospital epidemiology, and an infection control nurse.28

Hospital A is a public 250-bed hospital situated in the province of Buenos Aires, Argentina, with 1 medical/surgical ICU (10 beds) and 1 coronary ICU (10 beds). Hospital B is a private 150-bed hospital situated in the province of Buenos

Results

During the study period (July 1998-June 2002), 7284 adult patients were admitted to the study ICUs and a CVC-associated BSI developed in 213 (2.92%). Of those, 142 (66.6%) had a LOS ≥7 days and were included in the study. A total of 142 control patients, matched for LOS ≥7 days, hospital location, type of ICU, sex, age, and ASIS were paired with case patients. Incomplete matching on the basis of year of hospitalization occurred in 20 patients (14%), otherwise baseline characteristics were not

Discussion

The most important risk factor for BSI is CVC.4., 10., 11., 12. Patients who are critically ill often require prolonged CVC and have a high risk for the development of BSI.36., 37. When CVC-associated BSI does occur, a majority of studies have found an increased attributable mortality ranging from 4% to 37%2., 5., 9., 38., 39. although this association has not been a universal finding.7., 40.

In contrast, almost all studies that have sought to evaluate the impact of CVC-associated BSI on patient

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    Supported in part by a grant from Baxter Healthcare International.

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    Copyright © 2003 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.