title: Attributable costs and length of stay of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae outbreak in a neonatal intensive care unit.
abstract: OBJECTIVE
  To determine the costs of the interventions aimed at controlling the 4-month outbreak and to determine the attributable length of stay (LOS) associated with infection and colonization with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.
  
  
  METHODS
  A retrospective cost analysis was conducted from the hospital perspective. A micro-costing approach was employed. The LOS of four groups of hospitalized patients were compared with each other. National Perinatal Information Center criteria were used to stratify infants for severity of risk. The LOS of each group was compared with that of a national sample of similarly stratified infants.
  
  
  METHODS
  A level III-IV, 45-bed neonatal intensive care unit.
  
  
  METHODS
  Infant groups were infected (n = 8), colonized (n = 14), concurrent cohort (n = 54), and prior cohort (n = 486).
  
  
  RESULTS
  The cost of the outbreak totaled 341,751 dollars. The largest proportion of costs was related to healthcare worker time providing direct patient care (2,489 hours at a cost of 146,331 dollars). Infected and colonized neonates had longer LOS than either the concurrent cohort or the prior cohort (P < .001). Compared with the national sample, infected infants had a 48.5-day longer mean LOS (95% confidence interval [CI95], 1.7 to 95.2), whereas the prior cohort's mean LOS was 6 days shorter (CI95, -9.4 to -2.9).
  
  
  CONCLUSIONS
  This study increases the understanding of the burden of these multidrug-resistant organisms. Further research is needed to estimate the societal costs of these infections and the cost-effectiveness of preventive interventions.
authors.affiliation: School of Nursing, Columbia University, New York, New York, 10032, USA.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.forename: Archana
authors.initials: A
authors.lastname: Gupta
authors.forename: Maureen
authors.initials: M
authors.lastname: Loughrey
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.forename: Jeannie
authors.initials: J
authors.lastname: Cimiotti
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
authors.forename: David
authors.initials: D
authors.lastname: Rubenstein
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology; D004196:Disease Outbreaks / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000191:economics; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000191:economics* / Q000706:statistics & numerical data*; D007710:Klebsiella Infections / Q000191:economics* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000472:pathogenicity; D007902:Length of Stay; D009519:New York City / Q000453:epidemiology; D018571:Sentinel Surveillance; D001618:beta-Lactamases / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; D001618:beta-Lactamases