title: Hospital costs associated with nosocomial infections in a pediatric intensive care unit.
abstract: OBJECTIVE
  To estimate the additional cost attributable to nosocomial infection (NI) in a pediatric intensive care unit (PICU) and related factors.
  
  
  METHODS
  A prospective cohort study was conducted in all children admitted to the PICU of a tertiary-care pediatric hospital between 2008 and 2009. Descriptive and bivariate analyses were conducted of total direct costs due to PICU stay and medical procedures in patients with and without NI. A log-linear regression model was performed to determine the factors associated with higher total cost.
  
  
  RESULTS
  A total of 443 patients were studied and the prevalence of NI was 11.3%. The difference in the median total cost was €30,791.4 per patient between groups with and without NI. The median cost of PICU length of stay in patients with NI was almost eight times higher than the median cost of patients without NI. In patients with NI, the highest costs related to medical procedures were associated with antibiotics, enteral and parenteral feeding, and imaging tests. In the multivariate model, the factors associated with higher cost were infection, the performance of cardiovascular surgery, urgent admission, a higher pediatric risk mortality score, and the presence of immunosuppression. By contrast, older children and those with surgical admission generated lower cost.
  
  
  CONCLUSIONS
  NI was associated with an increase in total cost, which implies that the prevention of these infections through specific interventions could be cost-effective and would help to increase the safety of healthcare systems.
authors: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, España. Electronic address: aurea.morillo@gmail.com.
authors: Áurea
authors: Á
authors: Morillo-García
authors: Planes Integrales de Salud, Dirección General de Asistencia Sanitaria y Resultados en Salud, Servicio Andaluz de Salud, Sevillla, España.
authors: Josefa M
authors: JM
authors: Aldana-Espinal
authors: Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
authors: Antonio
authors: A
authors: Olry de Labry-Lima
authors: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors: Raquel
authors: R
authors: Valencia-Martín
authors: Servicio de Medicina Preventiva y Salud Pública, Hospital Infanta Elena, Huelva, España.
authors: Reyes
authors: R
authors: López-Márquez
authors: Unidad de Cuidados Críticos y Urgencias Pediátricas, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors: Mercedes
authors: M
authors: Loscertales-Abril
authors: Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors: Manuel
authors: M
authors: Conde-Herrera
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D018803:Models, Economic; D010372:Pediatrics / Q000191:economics*; D011446:Prospective Studies; D013030:Spain
keywords: Cohort studies; Cohortes; Costes; Costes hospitalarios; Healthcare costs; Hospital costs; Infección nosocomial; Intensive Care Units, Pediatric; Nosocomial infection; Regresión; Regression analysis; Unidad de Cuidados Intensivos Pediátricos