Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit.
OBJECTIVE
Catheter-related bloodstream infection (CRBSI) in critically ill surgical patients with prolonged intensive care unit (ICU) stays is associated with a significant increase in health care resource use.


METHODS
Prospective cohort study.


METHODS
Surgical ICU at a large tertiary care center.


METHODS
Critically ill surgical patients (N = 260) with projected surgical ICU length of stay greater than 3 days.


METHODS
Central venous catheters were cultured for clinical suspicion of infection.


METHODS
Increases in total hospital cost, ICU cost, hospital days, and ICU days attributable to CRBSI were estimated using multiple linear regression after adjusting for demographic factors and severity of illness (APACHE III [Apache Physiology and Chronic Health Evaluation III] score).


RESULTS
The incidence of CRBSI per 1000 catheter-days was 3.6 episodes (95% confidence interval [CI], 2.1-5.8 episodes). Microbiologic isolates were Gram-positive bacteria in 75%, Gram-negative bacteria in 20%, and yeast in 5%. After adjusting for demographic factors and severity of disease, CRBSI was associated with an increase of $56 167 (95% CI, $11 523-$165 735; P =.001) (in 1998 dollars) in total hospital cost, an increase of $71 443 (95% CI, $11 960-$195 628; P<.001) in ICU cost, a 22-day increase in hospital length of stay, and a 20-day increase in ICU length of stay.


CONCLUSIONS
For critically ill surgical patients, CRBSI is associated with a profound increase in resource use. Prevention, early diagnosis, and intervention for CRBSI might result in cost savings in this high-risk population.
Dimick
J B
JB
Department of Surgery, School of Medicine, The Johns Hopkins University, 600 N Wolfe St, Blalock 685/683, Baltimore, MD 21287-4685, USA.
Pelz
R K
RK
Consunji
R
R
Swoboda
S M
SM
Hendrix
C W
CW
Lipsett
P A
PA
D018806:APACHE; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D015142:Baltimore; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics / Q000639:trends*; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D009181:Mycoses / Q000517:prevention & control; D011446:Prospective Studies
D000935:Antifungal Agents; D015725:Fluconazole