Skip to main content
×
×
Home

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

  • Francisco Higuera (a1), Manuel Sigfrido Rangel-Frausto (a2), Victor Daniel Rosenthal (a3), Jose Martinez Soto (a4), Jorge Castañon (a2), Guillermo Franco (a1), Natividad Tabal-Galan (a2), Javier Ruiz (a1), Pablo Duarte (a1) and Nicholas Graves (a5)...
Abstract
Background.

No information is available about the financial impact of central venous catheter (CVC)-associated bloodstream infection (BSI) in Mexico.

Objective.

To calculate the costs associated with BSI in intensive care units (ICUs) in Mexico City.

Design.

An 18-month (June 2002 through November 2003), prospective, nested case-control study of patients with and patients without BSI.

Setting.

Adult ICUs in 3 hospitals in Mexico City.

Patients and Methods.

A total of 55 patients with BSI (case patients) and 55 patients without BSI (control patients) were compared with respect to hospital, type of ICU, year of hospital admission, length of ICU stay, sex, age, and mean severity of illness score. Information about the length of ICU stay was obtained prospectively during daily rounds. The daily cost of ICU stay was provided by the finance department of each hospital. The cost of antibiotics prescribed for BSI was provided by the hospitals' pharmacy departments.

Results.

For case patients, the mean extra length of stay was 6.1 days, the mean extra cost of antibiotics was $598, the mean extra hospital cost was $11,591, and the attributable extra mortality was 20%.

Conclusions.

In this study, the duration of ICU stay for patients with central venous catheter-associated BSI was significantly longer than that for control patients, resulting in increased healthcare costs and a higher attributable mortality. These conclusions support the need to implement preventive measures for hospitalized patients with central venous catheters in Mexico.

Copyright
Corresponding author
Medical College of Buenos Aires, Arengreen 1366, Buenos Aires, 1405, Argentina (victor_rosenthal@fibertel.com.ar)
References
Hide All
1. Miller, PJ, Farr, BM. Morbidity and mortality associated with multiple episodes of nosocomial bloodstream infection: a cohort study. Infect Control Hosp Epidemiol 1989;10:216219.
2. Smith, RL, Meixler, SM, Simberkoff, MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest 1991;100:164167.
3. Pittet, D, Li, N, Wenzel, RP. Association of secondary and polymicrobial nosocomial bloodstream infections with higher mortality. Eur J Clin Microbiol Infect Dis 1993;12:813819.
4. Velez, LA, Maki, DG. Analysis of risk factors for mortality in nosocomial bloodstream infection: a case-control study [abstract]. In: Program and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy (Anaheim, CA). Washington, DC: American Society for Microbiology, 1992:1164.
5. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:15981601.
6. Pittet, D, Wenzel, R. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:11771184.
7. 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;160:976981.
8. Leibovici, L, Paul, M, Weinberger, M, et al. Excess mortality in women with hospital-acquired bloodstream infection. Am J Med 2001;111:120125.
9. Jamulitrat, S, Meknavin, U, Thongpiyapoom, S. Factors affecting mortality outcome and risk of developing nosocomial bloodstream infection. Infect Control Hosp Epidemiol 1994;15:163170.
10. 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;31:475480.
11. Tokars, JI, Cookson, ST, McArthur, MA, Boyer, CL, McGeer, AJ, Jarvis, WR. Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy. Ann Intern Med 1999;131:340347.
12. Gowardman, JR, Montgomery, C, Thirlwell, S, et al. Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients. Intensive Care Med 1998;24:10341039.
13. Karchmer, AW. Nosocomial bloodstream infections: organisms, risk factors, and implications. Clin Infect Dis 2000;31(Suppl 4):S139S143.
14. Orsi, GB, Di Stefano, L, Noah, N. Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol 2002;23:190197.
15. Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Orellano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31:8592.
16. Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251269.
17. Rosenthal, VD, Guzman, S, Pezzotto, SM, Crnich, CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 2003;31:405409.
18. Maki, D. The epidemiology and prevention of nosocomial bloodstream infections [abstract]. In: Programs and abstracts of the Third International Conference on Nosocomial Infections (Atlanta, GA). Atlanta: ASM Press;1990:3.
19. Sitges-Serra, A. Strategies for prevention of catheter-related bloodstream infections. Support Care Cancer 1999;7:391395.
20. Crnich, CJ, Maki, DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection, I: pathogenesis and short-term devices. Clin Infect Dis 2002;34:12321242.
21. Crnich, CJ, Maki, DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection, II: long-term devices. Clin Infect Dis 2002;34:13621368.
22. Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257266.
23. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759769.
24. Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter: a randomized, controlled trial. Ann Intern Med 1997;127:257266.
25. Scheckler, WE, Brimhall, D, Buck, AS, et al; Society for Healthcare Epidemiology of America. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hosp Epidemiol 1998;19:114124.
26. Higuera, F, Rosenthal, VD, Duarte, P, Ruiz, J, Franco, G, Safdar, N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005;33:20222027.
27. Bergman, U. The history of the Drug Utilization Research Group in Europe. Pharmacoepidemiol Drug Saf 2006;15:9598.
28. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infection. Am J Infect Control 1988;16:128140.
29. Maki, DG, Weise, CE, Sarafin, HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977;296:13051309.
30. Villanova, P. Minimum Inhibitory Concentration Interpretive Standards. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M7-A4.
31. Balows, A, Hausler, W. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991.
32. Gaynes, RP, Culver, DH, Emori, TG, et al. The National Nosocomial Infections Surveillance System: plans for the 1990s and beyond. Am J Med 1991;91:116S120S.
33. Haley, R. Cost-benefit analysis of infection control programs. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston: Lippincott-Raven, 1992:249267.
34. Maxwell, M, Heaney, D, Howie, JG, Noble, S. General practice fundholding: observations on prescribing patterns and costs using the defined daily dose method. BMJ 1993;307:11901194.
35. Liu, JW, Su, YK, Liu, CF, Chen, JB. Nosocomial blood-stream infection in patients with end-stage renal disease: excess length of hospital stay, extra cost and attributable mortality. J Hosp Infect 2002;50:224227.
36. Elward, AM, Hollenbeak, CS, Warren, DK, Fraser, VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 2005;115:868872.
37. Payne, NR, Carpenter, JH, Badger, GJ, Horbar, JD, Rogowski, J. Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 2004;114:348355.
38. Warren, DK, Zack, JE, Elward, AM, Cox, MJ, Fraser, VJ. Nosocomial primary bloodstream infections in intensive care unit patients in a non-teaching community medical center: a 21-month prospective study. Clin Infect Dis 2001;33:13291335.
39. Mahieu, LM, De Dooy, JJ, Lenaerts, AE, leven, MM, De Muynck, AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001 48:2026.
40. Collignon, PJ. Intravascular catheter associated sepsis: a common problem. The Australian Study on Intravascular Catheter Associated Sepsis. Med J Aust 1994;161:374378.
41. Dimick, JB, Pelz, RK, Consunji, R, Swoboda, SM, Hendrix, CW, Lipsett, PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001;136:229234.
42. 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;160:976981.
43. Relio, J, Ochagavia, A, Sabanes, E, et al. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 2000;162:10271030.
44. Kollef, MH. Antibiotic use and antibiotic resistance in the intensive care unit: are we curing or creating disease? Heart Lung 1994;23:363367.
45. Crnich, CJ, Maki, DG. In consultation: new technology for reducing infection and resistance in the ICU. J Crit Illn 2002;17:4851.
46. Lopez-Lozano, JM, Monnet, DL, Yague, A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000;14:2131.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed