title: Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital.
abstract: OBJECTIVE
  To determine the attributable cost and length of stay of intensive care unit (ICU)-acquired, catheter-associated bloodstream infections from a hospital-based cost perspective, after adjusting for potential confounders.
  
  
  METHODS
  Patients admitted to the ICU between January 19, 1998, and July 31, 2000, were observed prospectively for the occurrence of catheter-associated bloodstream infections. Hospital costs were obtained from the hospital cost accounting database.
  
  
  METHODS
  The medical and surgical ICUs at a 500-bed suburban, tertiary care hospital.
  
  
  METHODS
  Patients requiring central venous catheterization while in the ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  We measured occurrence of catheter-associated bloodstream infection, in-hospital mortality rate, total ICU and hospital lengths of stay, and total hospital costs. Catheter-associated bloodstream infection occurred in 41 of 1,132 patients (3.6 cases per 1000 catheter days). Patients with catheter-associated bloodstream infection had significantly higher unadjusted ICU length of stay (median, 24 vs. 5 days; p < .001), hospital length of stay (median, 45 vs. 11 days; p < .001), mortality rate (21 [51%] vs. 301 [28%], p = .001), and total hospital costs (83,544 dollars vs. 23,803 dollars, p < .001). Controlling for other factors that may affect costs and lengths of stay, catheter-associated bloodstream infections resulted in an attributable cost of 11,971 dollars (95% confidence interval, 6,732 dollars-18,352 dollars), ICU length of stay of 2.41 days (95% confidence interval, 0.08-3.09 days), and hospital length of stay of 7.54 days (95% confidence interval, 3.99-11.09 days).
  
  
  CONCLUSIONS
  Patients with catheter-associated bloodstream infection had significantly longer ICU and hospital lengths of stay, with higher unadjusted total mortality rate and hospital cost compared with uninfected patients. After adjusting for underlying severity of illness, the attributable cost of catheter-associated bloodstream infection was approximately 11,971 dollars.
authors.affiliation: Divisions of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Wasim W
authors.initials: WW
authors.lastname: Quadir
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Alexis M
authors.initials: AM
authors.lastname: Elward
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cox
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000191:economics* / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008923:Missouri; D011446:Prospective Studies