Vancomycin-sensitive and vancomycin-resistant enterococcal infections in the ICU: attributable costs and outcomes.
OBJECTIVE
To determine the economic and clinical outcomes associated with infection with vancomycin-resistant Enterococcus (VRE) and to compare these outcomes to those associated with infection with vancomycin-sensitive Enterococcus (VSE).


METHODS
During a 3-month, prospective, cohort study of 117 high-risk, critically ill patients we collected complete clinical and demographic and ICU cost data from all patients during their ICU stays.


RESULTS
After adjusting for variables in a stepwise multiple regression model VRE infections were associated with a median attributable increased ICU cost per patient of $33,251 (38,088 euros) and an increased length of hospital stay (LOS) of 22 days, while VSE infections were associated with an increased cost of $21,914 (25,102 euros) and an increased LOS of 27 days. The effect of VRE and VSE infections were not significantly different. Over the entire cohort the attributable cost per ICU patient day associated with VRE infection was $304 (348 euros).


CONCLUSIONS
The attributable cost of ICU care associated with VRE infection is $33,251 (38,088 euros) and per ICU patient day was $304 (348 euros). VRE and VSE infections do not differ in associated cost of ICU care, LOS, or mortality. Any VRE control strategy is be cost-effective if the overall cost per ICU patient-day is less than $304 (348 euros).
Pelz
Robert K
RK
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Lipsett
Pamela A
PA
Swoboda
Sandra M
SM
Diener-West
Marie
M
Powe
Neil R
NR
Brower
Roy G
RG
Perl
Trish M
TM
Hammond
Janet M
JM
Hendrix
Craig W
CW
D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000145:classification / Q000191:economics*; D023381:Endpoint Determination; D016983:Enterococcus; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D016031:Liver Transplantation / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin