title: Health care institutional charges associated with ambulatory bloodstream infections in pediatric oncology and stem cell transplant patients.
abstract: The impact of ambulatory bloodstream infections (Amb-BSIs) in pediatric oncology and stem cell transplant (PO/SCT) patients is poorly understood, although a large portion of their treatment increasingly occurs in this setting. This study aimed to understand the economic impact and length of stay (LOS) associated with these infections.
  
  
  
  Charges and LOS were retrospectively collected and analyzed for Amb-BSI events leading to a hospital admission between 2012 and 2013 in a tertiary, university-affiliated hospital. Events were grouped as BSI-MIXED when hospitalizations with care unrelated to the infection-extended LOS by more than 24 hr or as BSI-PURE for all others. Billing codes were used to group charges and main drivers were analyzed.
  
  
  
  Seventy-four BSI events were identified in 61 patients. Sixty-nine percent met definition for central line-associated BSI (CLABSI). Median total charge and LOS for an Amb-BSI were $40,852 (interquartile range [IQR] $44,091) and 7 days (IQR 6), respectively. Median charges for BSI-PURE group (N = 62) were $36,611 (IQR $34,785) and $89,935 (IQR $153,263) in the BSI-MIXED (N = 12) group. Median LOS was 6 (IQR 5) days in the BSI-PURE group and 15 (IQR 24) in the BSI-MIXED. Room, pharmacy, and procedure charges accounted for more than 70% of total charges in all groups.
  
  
  
  Amb-BSIs in PO/SCT patients result in significant healthcare charges and unplanned extended hospital admissions. This analysis suggests that efforts aiming at reducing rates of infections could result in substantial system savings, validating the need for increased efforts to prevent Amb-BSIs.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Chris I
authors.initials: CI
authors.lastname: Wong Quiles
authors.affiliation: Department of Population Management and Value, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gottsch
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Usha
authors.initials: U
authors.lastname: Thakrar
authors.affiliation: Department of Population Management and Value, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Belen
authors.initials: B
authors.lastname: Fraile
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Billett
mesh_terms: D000553:Ambulatory Care; D016470:Bacteremia / Q000191:economics* / Q000209:etiology; D001419:Bacteria / Q000302:isolation & purification; D002675:Child, Preschool; D003141:Communicable Diseases / Q000150:complications / Q000191:economics* / Q000382:microbiology / Q000628:therapy; D003428:Cross Infection / Q000191:economics* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000639:trends; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000191:economics* / Q000382:microbiology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics*
keywords: central venous line; charges; infections; length of stay; pediatric oncology; stem cell transplantation