title: Healthcare-associated infections in acute ischaemic stroke patients from 36 Japanese hospitals: risk-adjusted economic and clinical outcomes.
abstract: BACKGROUND
  Healthcare-associated infections are a major cause for worsening in ischaemic stroke patients. In addition to increased morbidity and mortality, healthcare-associated infections also result in a potentially preventable increase in economic costs.
  
  
  OBJECTIVE
  The aim of this study was to identify healthcare-associated infection incidence in ischaemic stroke patients in Japanese hospitals, and to conduct a risk-adjusted analysis of the associated economic and clinical outcomes.
  
  
  METHODS
  Healthcare-associated infections were identified in 36 Japanese hospitals using an administrative database. Identification was carried out using a combination of International Classification of Diseases-10 codes and antibiotic utilisation patterns that indicated the presence of an infection. Risk-adjusted hospital charges and length of stay were calculated using multiple linear regression analyses correcting for patient and hospital factors. A logistic regression model was used to analyse the association between healthcare-associated infection infection and mortality.
  
  
  RESULTS
  There was an overall healthcare-associated infection incidence of 16·4%, with an interhospital range of 4·7-28·3%. After risk-adjustment, infected cases paid an additional US$3,067 per admission (interhospital range US$434-US$7,151) and were hospitalised for an additional 16·3-days (interhospital range: 5·1-25·1-days) when compared with uninfected patients. Healthcare-associated infections also had a strongly significant association with increased mortality (odds ratio=23·2, 95% confidence intervals: 12·5-43·2).
  
  
  CONCLUSIONS
  We observed a wide range of healthcare-associated infection incidence between the hospitals. Healthcare-associated infections were found to be significantly associated with increased hospital charges, length of stay, and mortality. Furthermore, the use of risk-adjusted multi-institutional comparisons allowed us to analyse individual performance levels in both infection and cost control.
authors.affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otsubo
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications* / Q000191:economics / Q000628:therapy; D003128:Coma / Q000209:etiology; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000191:economics / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020379:Risk Adjustment; D020521:Stroke / Q000150:complications* / Q000191:economics / Q000628:therapy; D016896:Treatment Outcome