Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs.
OBJECTIVE
To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it.


METHODS
A population-based, matched, historical cohort study.


METHODS
A 1,025-bed, university-based teaching facility and referral hospital.


METHODS
Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000.


RESULTS
The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, dollars 77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and dollars 81,208, respectively.


CONCLUSIONS
Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
Xiaoyan
X
Song
Arjun
A
Srinivasan
David
D
Plaut
Trish M
TM
Perl
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000191:economics* / Q000401:mortality* / Q000635:transmission; D003428:Cross Infection; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D020713:Vancomycin Resistance