title: Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients.
abstract: OBJECTIVE
  Nosocomial infections have been shown to be associated with increased attributable mortality, length of hospital stay, and health care costs in studies mainly conducted in western populations. However, the health care system in Taiwan differs from the typical situation in western countries, with longer hospitalization times and lower daily costs. The purpose of this study was to understand the economic and clinical impacts of nosocomial infections in Taiwan.
  
  
  METHODS
  Between June 1, 2001 and December 31, 2001, every hospitalized patient (age >/= 16 years) with nosocomial infections (case group) and matched control patients without nosocomial infections of the same age, gender, underlying medical illness, clinical diagnosis at admission and disease severity (control group) were recruited. Demographic characteristics, length of hospitalization, costs and final outcomes of both groups were collected for analysis.
  
  
  RESULTS
  A total of 482 patient-pairs with median age of 68 years were studied. The median length of hospital stay was 40 days for the case group and 22 days for the control group (p < 0.0001). The median hospital cost for the case group was 363,425 New Taiwan Dollars (NTD) and 165,965 NTD for the control group (p < 0.0001). The median additional hospital stay for patients with nosocomial infection was 15 days, which amounted to 127,354 NTD. The extra hospital costs were not only associated with accommodation but also fees for materials, and costs relating to pharmacy, laboratory tests and diet. Patients with nosocomial infections were more likely to have shock, organ failure and death (all p < 0.0001). Additional hospital stay and costs were not related to various infection sites and bacterial pathogens causing nosocomial infections; however, medical costs attributable to nosocomial fungal infection were higher than that of bacterial infections.
  
  
  CONCLUSIONS
  Nosocomial infections have a significant impact on the length of hospital stay and medical care cost. Extra costs of nosocomial infections resulted not only from prolongation of hospital stay, but also other medical costs. Infection control for preventing nosocomial infections may play an important role in reducing medical costs, hospital stay, and mortality in hospitalized patients.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology