Warren David K, Quadir Wasim W, Hollenbeak Christopher S, Elward Alexis M, Cox Michael J, Fraser Victoria J
Divisions of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
Crit Care Med. 2006 Aug;34(8):2084-9. doi: 10.1097/01.CCM.0000227648.15804.2D.
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.
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.
The medical and surgical ICUs at a 500-bed suburban, tertiary care hospital.
Patients requiring central venous catheterization while in the ICU.
None.
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).
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.
从医院成本角度，在调整潜在混杂因素后，确定重症监护病房（ICU）获得性、导管相关血流感染的归因成本和住院时间。
对1998年1月19日至2000年7月31日期间入住ICU的患者进行前瞻性观察，以了解导管相关血流感染的发生情况。医院成本来自医院成本核算数据库。
一家拥有500张床位的郊区三级护理医院的内科和外科ICU。
在ICU期间需要中心静脉置管的患者。
无。
我们测量了导管相关血流感染的发生率、院内死亡率、ICU和医院的总住院时间以及医院总成本。1132例患者中有41例发生导管相关血流感染（每1000导管日3.6例）。发生导管相关血流感染的患者未经调整的ICU住院时间显著更长（中位数，24天对5天；p<.001），医院住院时间（中位数，45天对11天；p<.001），死亡率（21例[51%]对301例[28%]，p=.001），以及医院总成本（83544美元对23803美元，p<.001）。在控制可能影响成本和住院时间的其他因素后，导管相关血流感染导致归因成本为11971美元（95%置信区间，6732美元 - 18352美元），ICU住院时间为2.41天（95%置信区间，0.08 - 3.09天），医院住院时间为7.54天（95%置信区间，3.99 - 11.09天）。
与未感染患者相比，发生导管相关血流感染的患者ICU和医院住院时间显著更长，未经调整的总死亡率和医院成本更高。在调整基础疾病严重程度后，导管相关血流感染的归因成本约为11971美元。
