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The Direct Costs of Nosocomial Catheter-Associated Urinary Tract Infection in the Era of Managed Care

  • Paul A. Tambyah (a1), Valerie Knasinski (a1) and Dennis G. Maki (a1)
Abstract
AbstractObjective:

To determine the additional direct costs of hospitalization attributable to catheter-associated urinary tract infection (CAUTI) in 1,497 newly catheterized patients.

Design:

Prospective observational and laboratory study.

Setting:

University hospital.

Methods:

Data were collected on risk factors for CAUTI (defined as > 103 colony-forming units [CFU]/mL), severity of illness, and diagnostic and therapeutic interventions in consenting newly catheterized patients. Daily urine cultures were obtained from each newly catheterized patient, but the results of these cultures were not revealed to his or her physician. During the study, one of the investigators (DGM) reviewed each patient's record and made a judgment as to which of the diagnostic tests and treatments ordered and what incremental length of stay could reasonably be ascribed to his or her CAUTI. The total hospital costs for each patient were also obtained.

Results:

Overall, 235 patients acquired CAUTIs during the study; most of the CAUTIs were completely asymptomatic, and only 52% were diagnosed by the patients' physicians using the hospital laboratory. Only 1 patient with a CAUTI had a secondary bloodstream infection. Thirty-three (13%) of the CAUTIs were caused by Escherichia coli; 63 (25%) by Klebsiella, Enterobacter, Citrobacter, Pseudomonas aeruginosa, or other antibiotic-resistant, gram-negative bacilli; 87 (35%) by enterococci or staphylococci; and 67 (27%) by Candida species. The 123 CAUTIs diagnosed by the hospital laboratory were judged to have been responsible for an additional $20,662 in extra costs of diagnostic tests and $35,872 in extra medication costs, a mean of $589 (median, $356) per CAUTI. CAUTIs caused by E. coli cost considerably less than infections caused by other gram-negative bacilli ($363.3 ± $228.2 vs $690.4 ± $783.7; P = .02) or yeasts ($821.2 ± $2,169.9). There were less striking differences in the costs per CAUTI caused by staphylococci or enterococci ($387.1 ± $434.8).

Conclusions:

The extra direct costs associated with nosocomial CAUTI found in this prospective study, which was done in the era of managed care during the late 1990s, are substantially lower than those reported in the largest comparable studies done more than 15 years ago, most of which were retrospective, reflecting the powerful impact of cost-containment measures that are now implemented in managed care.

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Corresponding author
Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074
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2. WE Stamm . Catheter-associated urinary tract infections: epidemiology, pathogenesis and prevention. Am J Med 1991;91(suppl 3B):65S71S.

3. JW Warren . The catheter and urinary tract infection. Med Clin North Am 1991;75:481493.

4. JD Siebert , RB Thomson , JS Tan , LW Gerson . Emergence of anti-microbial resistance in gram-negative bacilli causing bacteremia during therapy. Am J Clin Pathol 1993;100:4751.

5. V Jarlier , T Fosse , A Philippon . Antibiotic susceptibility in aerobic gram-negative bacilli isolated in intensive care units in 39 French teaching hospitals. Intensive Care Medicine 1996;22:10571065.

7. RP Gaynes , RA Weinstein , W Chamberlin , S Kabins . Antibiotic-resistant flora in nursing home patients admitted to hospital. Arch Intern Med 1985;145:18041807.

8. WMM Kirby , DO Corpron , DC Tanner . Urinary tract infections caused by antibiotic-resistant coliform bacilli. JAMA 1956;162:1.

9. S Lam , C Singer , V Tucci , VH Morthland , MA Pfaller , HD Isenberg . The challenge of vancomycin-resistant enterococci: a clinical and epidemiologic study. Am J Infect Control 1995;23:170180.

10. DR Schaberg , RW Haley , AK Highsmith , RL Anderson , JE McGowan . Nosocomial bacteriuria: a prospective study of case clustering and antimicrobial resistance. Ann Intern Med 1980;93:420424.

12. L Rice , SH Willey , Papanicolau GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:21932199.

13. KG Naber , W Witte , A Bauernfeind , et al. Clinical significance and spread of fluoroquinolone resistant uropathogens in hospitalized urological patients. Infection 1994;22:S122S127.

15. RW Haley , DR Schaberg , KB Crossley , SD von Allmen , JE McGowan . Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:5158.

16. R Coello , H Glenister , J Fereres , et al. The cost of infection in surgical patients: a case control study. J Hosp Infect 1993;25:239250.

20. RA Garibaldi , JP Burke , ML Dickman , CB Smith . Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 1974;291:215219.

22. JR Johnson . PL Roberts , RJ Olsen , KA Moyer , WE Stamm . Prevention of catheter-associated urinary tract infection with a silver oxide-coated urinary catheter: clinical and microbiologic correlates. J Infect Dis 1990;162:11451150.

23. RP Stark , DG Maki . Bacteriuria in the catheterized patient: what quantitative level of bacteriuria is relevant? N Engl J Med 1984;311:560564.

26. PA Tambyah , DG Maki . Catheter-associated urinary tract infection is rarely symptomatic; a prospective study of 1,497 catheterized patients. Arch Intern Med 2000;160:678682.

27. WR Jarvis , WJ Martone . Predominant pathogens in hospital infections. J Antimicrob Chemother 1992;29:1924.

29. JC Robinson . Decline in hospital utilization and cost inflation under managed care in California. JAMA 1996;276:10601064.

30. DF Drake . Managed care: a product of market dynamics. JAMA 1997;277:560563.

31. RF Spengler , WB Greenlough III Hospital costs and mortality attributed to nosocomial bacteremias. JAMA 1978;240:24552458.

32. D Pittet , D Tarara , RP Wenzel . Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs and attributable mortality. JAMA 1994;271:15981601.

33. DG Maki , PA Tambyah . Engineering out the risk of infection with urinary catheters. Emerg Infect Dis 2001;7:342347.

34. S Saint . Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28:6875.

35. S Saint , DL Veenstra , SD Sullivan , C Chenoweth , M Fendrick . The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med 2000;160:26702675.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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