Elsevier

American Journal of Infection Control

Volume 36, Issue 10, December 2008, Pages S172.e1-S172.e3
American Journal of Infection Control

Brief report
Cost of bloodstream infections

https://doi.org/10.1016/j.ajic.2008.10.004Get rights and content

Background

Hospital-acquired bloodstream infections (BSIs) are relatively rare but do not occur randomly. This suggests that unobserved confounding factors can bias estimates of BSI-associated incremental costs of care. Compared with previous studies, this analysis used a large sample size for greater precision, actual cost-accounting data, and case matching combined with bounding estimates to correct for bias.

Methods

Data from 1,355,647 admissions during 69 months in 55 hospitals were collected from a large population database. BSIs were identified by the Nosocomial Infection Marker, a well-validated, electronic, laboratory-based marker used for automatic infection surveillance. Costs were obtained by matching laboratory data with hospital accounting system calculations and converted to 2006 US dollars.

Results

Of 58,376 presumed nosocomial infections, 12,578 (21.6%) were identified as BSIs. More than 50% of BSIs occurred within the first week of hospitalization and 80% during the first 2 weeks. Various analyses resulted in the following estimates of BSI-associated incremental costs: basic regression analysis, $19,643 (P < .0001; 95% confidence interval [CI]: $9026-$30,260); excluding infections occurring after day 14, $19,427 (P < .001; 95% CI: $8867-$29,986); excluding infections occurring after day 7, $20,600 (P < .001; 95% CI: $10,123-$30,077); controlling for other nosocomial infections, $12,774 (P < .001; 95% CI: $6257-$19,290); and controlling for length of stay, $5534 (P < .012; 95% CI: $1282-$9785).

Conclusion

Even when intentionally underestimated, BSI-associated increased costs are substantial. True costs of BSIs are likely to be between $10,000 and $20,000. More research is needed to explore how controlling BSI costs may affect the cost of inpatient care.

Section snippets

Data and methods

Study data were gathered from the records of 1,355,647 admissions during a period from March 2001 through January 2006 in 55 participating hospitals using the Cardinal Health/MedMined (Birmingham, AL) services installed database. Nosocomial infections (NIs) and BSIs were identified by the Nosocomial Infection Marker (NIM; copyright, patent pending, Cardinal Health, Inc), a well-validated, electronic, laboratory-based marker used for automatic infection surveillance.6 The NIM is defined as a

Results

Data from 1,355,647 admissions included information on 58,376 presumed NIs; of these, 12,578 (21.6%) were identified as BSIs. Basic regression analysis yielded an estimated BSI-associated incremental cost of $19,643 (P < .0001; 95% confidence interval [CI]: $9026-$30,260). The distribution of BSIs as a function of LOS showed that more than half of all BSIs occurred within the first week of hospitalization and that 80% occurred within the first 2 weeks (Fig 1).

. Bloodstream infections: cumulative

Discussion

This analysis of infections that occurred before hospital day 14 showed that BSIs were associated with increased costs of care of $19,643, which is consistent with previous estimates. The significance of these findings relate to the large sample size, which provided greater precision compared with previous studies and the use of actual cost-accounting data rather than charges or reimbursements.

How cost estimates may be biased by unobserved factors was also explored. When infections that

Conclusion

Even when intentionally underestimated, BSI-associated increased costs are substantial. The true incremental cost of care associated with BSIs is likely to lie between $10,000 and $20,000. Further research is needed to explore how controlling BSI costs may affect costs of inpatient care.

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Disclosures: Dr. Kilgore received an honorarium for participating in the symposium and writing this article.

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