Yin-Yin Chen

IMPACT OF NOSOCOMIAL INFECTION ON COST OF ILLNESS AND LENGTH OF STAY IN INTENSIVE CARE UNITS

OBJECTIVE Economic evaluation has become increasingly important in healthcare and infection control. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). DESIGN A retrospective cohort study. SETTING Medical, surgical, and mixed medical and surgical ICUs in a tertiary-care referral medical center. PATIENTS Patients admitted to adult ICUs between October 2001 and June 2002 were eligible for the study. METHODS Estimates of the cost and LOS for patients who acquired a nosocomial infection were computed using a stratified analysis and regression approach. RESULTS During the study period, 778 patients were admitted to the ICUs. Total costs for patients with and without nosocomial infections (median cost, 10,354 dollars and 3985 dollars, respectively) were significantly different (P < .05). The costs stratified by infection site (median differences from 4687 dollars to 7365 dollars) and primary diagnosis (median differences from 5585 dollars to 16,507 dollars) were also significantly different (P < .05) except for surgical-site infection. After covariates were adjusted for in the multiple linear regression, nosocomial infection increased the total costs by 3306 dollars per patient and increased the LOS by 18.2 days per patient (P < .001). Each additional day spent in the ICU increased the cost per patient by 353 dollars (P < .001). CONCLUSIONS Nosocomial infections are associated with increased cost of illness and LOS. Prevention of nosocomial infections should reduce direct costs and decrease the LOS.

Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia

BACKGROUND Infections due to methicillin-resistant Staphylococcus aureus have become increasingly common in hospitals worldwide. S aureus continues to be a cause of nosocomial bacteremia. METHODS We analyzed the clinical significance (mortality) of MRSA and methicillin-susceptible S aureus bacteremia in a retrospective cohort study in a 2900-bed tertiary referral medical center. Survival and logistic regression analyses were used to determine the risk factors and prognostic factors of mortality. RESULTS During the 15-year period, 1148 patients were diagnosed with nosocomial S aureus bacteremia. After controlling potential risk factors for MRSA bacteremia on logistic regression analysis, service, admission days prior to bacteremia, age, mechanical ventilator, and central venous catheter (CVC) were independent risk factors for MRSA. The crude mortality rate of S aureus bacteremia was 44.1%. The difference between the mortality rates of MRSA (49.8%) and MSSA bacteremia (27.6%) was 22.2% (P < .001). Upon logistic regression analysis, the mortality with MRSA bacteremia was revealed to be 1.78 times higher than MSSA (P < .001). The other predicted prognostic factors included age, neoplasms, duration of hospital stay after bacteremia, presence of mechanical ventilator, and use of CVC. CONCLUSIONS Resistance to methicillin was an important independent prognostic factor for patients with S aureus bacteremia.

Incidence Rate and Variable Cost of Nosocomial Infections in Different Types of Intensive Care Units

OBJECTIVE Nosocomial infection (NI) is one of the most serious healthcare issues currently influencing healthcare costs. This study estimates the impact of NI on costs in intensive care units (ICUs). DESIGN Prospective surveillance by a retrospective cohort study. SETTING A medical ICU, a surgical ICU, and a mixed medical and surgical ICU in a large tertiary referral medical center. METHODS Surveillance for NIs was conducted for all patients admitted to adult ICUs from 2003 through 2005. Retrospective chart review was conducted for each patient. The generalized linear modeling approach was used to assess the relationship of NIs to the increase in variable costs in individual ICUs and in all ICUs. RESULTS A total of 401 NIs occurred in 320 of 2,757 screened patients. The incidence rate was 12.1% in the medical ICU, 14.7% in the surgical ICU, and 16.7% in the mixed medical and surgical ICU (P>.05). All of the mean variable costs were significantly higher for patients with NI than they were for patients without NI, after controlling for covariates. The medical ICU had the greatest increase in mean cost (

A risk factor analysis of healthcare-associated fungal infections in an intensive care unit: a retrospective cohort study

13,456, which was 3.52 times [95% confidence interval {CI}, 2.94-4.22 times] the mean cost for patients without NI), followed by the mixed medical and surgical ICU (

Changes in the incidence of candidaemia during 2000–2008 in a tertiary medical centre in northern Taiwan

6,748, which was 2.74 times [95% CI, 2.33-3.22 times] the mean cost for patients without NI) and the surgical ICU (

Using A Criteria-Based Reminder To Reduce Use Of Indwelling Urinary Catheters And Decrease Urinary Tract Infections

5,433, which was 2.46 times [95% CI, 1.99-3.05 times] the mean cost for patients without NI). Mean cost increases according to the site of NI were

Comparison between replacement at 4 days and 7 days of the infection rate for pulmonary artery catheters in an intensive care unit.

6,056 for bloodstream infection (2.36 times [95% CI, 1.97-2.84 times] the mean cost for patients without NI),

Prognostic factors and clinical features of non-typhoid Salmonella bacteremia in adults.

4,287 for respiratory tract infection (1.91 times [95% CI, 1.57-2.32 times] the mean cost for patients without NI),

Analysis of sharp-edged medical-object injuries at a medical center in Taiwan

1,955 for urinary tract infection (1.42 times [95% CI, 1.18-1.72 times] the mean cost for patients without NI), and

Surveillance on secular trends of incidence and mortality for device–associated infection in the intensive care unit setting at a tertiary medical center in Taiwan, 2000–2008: A retrospective observational study

1,051 for surgical site infection (1.23 times [95% CI, 0.90-1.68 times] the mean cost for patients without NI). CONCLUSIONS The medical ICU had the lowest rate of NI and the largest excess costs, the surgical ICU had the lowest excess costs, and the mixed medical and surgical ICU had the highest rate of NI. The cost is largely attributable to bloodstream infection and respiratory tract infection.