title: Impact of superinfection on hospital length of stay and costs in patients with ventilator-associated pneumonia.
abstract: Ventilator-associated pneumonia (VAP) increases length of stay (LOS) in VAP versus non-VAP patients, but LOS differences among VAP patients remain unexplained. We explored the economic impact of developing a respiratory superinfection while being treated for VAP. This was a retrospective, observational cohort study conducted in 74 patients discharged between January 2004 and July 2005 identified as having VAP. Using detailed, chart-abstracted demographic and hospital-course data--including antibiotic therapy, APACHE II scores, and superinfection development--multivariable analysis determined variables independently associated with LOS and total accounting costs from the date of VAP identification (VAP ID) to discharge or death. Overall mortality and mean +/- SD APACHE II were 35% and 19.4 +/- 8.9 for 74 cases; 35% of the cohort developed a superinfection. Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella spp. were most frequently responsible. Mortality was unaffected by superinfection. Younger age (P = 0.003), superinfection (P = 0.006), and admission to the surgical intensive care unit (ICU) (P = 0.014) independently predicted LOS (adjusted R(2) = 0.296). Younger age (P < 0.001), admission to the surgical ICU (P = 0.004), superinfection (P = 0.002), and previous antibiotic exposure (P = 0.009) predicted increased costs (adjusted R(2) = 0.394). Mean (95% CI) LOS and total costs after contracting VAP were greater for superinfection patients [47.8 days (39.0 to 56.5) versus 27.9 (22.4 to 33.1), P < 0.001; $140,850 ($98,426 to $183,275) versus $73,801 ($58,946-$88,656), P < 0.001], with 15.6 days and $48,527 attributable to superinfection. While not affecting mortality in those patients with VAP, superinfections independently predict increased LOS after VAP ID, contributing to substantial additional cost.
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Eagye
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kuti
mesh_terms: D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D017281:Cost of Illness; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D012189:Retrospective Studies; D015163:Superinfection / Q000191:economics* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents