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Attributable Costs of Enterococcal Bloodstream Infections in a Nonsurgical Hospital Cohort

Published online by Cambridge University Press:  02 January 2015

Anne M. Butler ,
Margaret A. Olsen ,
Liana R. Merz ,
Rebecca M. Guth ,
Keith F. Woeltje ,
Bernard C. Camins  and
Victoria J. Fraser
Anne M. Butler*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Liana R. Merz
Affiliation:
Center for Clinical Excellence, BJC HealthCare, St Louis, Missouri
Rebecca M. Guth
Affiliation:
Pediatric Quality Management, St Louis Children's Hospital (R.M.G.), St Louis, Missouri
Keith F. Woeltje
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Bernard C. Camins
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
*
Department of Epidemiology, Gillings School of Global Public Health, CB 7435, University of North Carolina, Chapel Hill, NC 27599-7435 ([email protected])
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Extract

Background.

Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with increased morbidity and mortality.

Objective.

To determine the hospital costs and length of stay attributable to VRE BSI and vancomycin-sensitive Enterococcus (VSE) BSI and the independent effect of vancomycin resistance on hospital costs.

Methods.

A retrospective cohort study was conducted of 21,154 nonsurgical patients admitted to an academic medical center during the period from 2002 through 2003. Using administrative data, attributable hospital costs (adjusted for inflation to 2007 US dollars) and length of stay were estimated with multivariate generalized least-squares (GLS) models and propensity score-matched pairs.

Results.

The cohort included 94 patients with VRE BSI and 182 patients with VSE BSI. After adjustment for demographics, comorbidities, procedures, nonenterococcal BSI, and early mortality, the costs attributable to VRE BSI were $4,479 (95% confidence interval [CI], $3,500-$5,732) in the standard GLS model and $4,036 (95% CI, $3,170-$5,140) in the propensity score-weighted GLS model, and the costs attributable to VSE BSI were $2,250 (95% CI, $l,758-$2,880) in the standard GLS model and $2,023 (95% CI, $1,588-$2,575) in the propensity score-weighted GLS model. The median values of the difference in costs between matched pairs were $9,949 (95% CI, $1,579-$24,693) for VRE BSI and $5,282 (95% CI, $2,042-$8,043) for VSE BSI. The costs attributable to vancomycin resistance were $1,713 (95% CI, $1,338-$2,192) in the standard GLS model and $1,546 (95% CI, $1,214-$1,968) in the propensity score-weighted GLS model. Depending on the statistical method used, attributable length of stay estimates ranged from 2.2 to 3.5 days for patients with VRE BSI and from 1.1 to 2.2 days for patients with VSE BSI.

Conclusions.

VRE BSI and VSE BSI were independently associated with increased hospital costs and increased length of stay. Vancomycin resistance was associated with increased costs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 28 - 35
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Song, X, Srinivasan, A, Plaut, D, Perl, TM. Effect of nosocomial vancomycin-resistant enterococcal bacteremia of mortality, length of stay, and costs. Infect Control Hosp Epidemiol 2003;24:251–256.Google Scholar
2.DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-suscep-tible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.Google Scholar
3.Salgado, CD, Farr, BM. Outcomes associated with vancomycin-resistant enterococci: a meta-analysis. Infect Control Hosp Epidemiol 2003;24:690–698.CrossRefGoogle ScholarPubMed
4.Stosor, V, Peterson, LR, Postelnick, M, Noskin, GA. Enterococcus faecium bacteremia: does vancomycin resistance make a difference? Arch Intern Med 1998;158:522–527.Google Scholar
5.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.CrossRefGoogle ScholarPubMed
6.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
7.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
8.Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance of health and economic outcomes. Clin Infect Dis 2003;36:1433–1437.Google Scholar
9.Kaye, KS, Engemann, JJ, Mozaffari, E, Carmeli, Y. Reference group choice and antibiotic resistance outcomes. Emerg Infect Dis 2004;10:1125–1128.Google Scholar
10.Pelz, RK, Lipsett, PA, Swoboda, SM, et al. Vancomycin-sensitive and vancomycin-resistant enterococcal infections in the ICU: attributable costs and outcomes. Intensive Care Med 2002;28:692–697.Google Scholar
11.Bureau of Labor Statistics. Consumer Price Index. Available at: http://www.bls.gov/. Accessed January 15, 2009.Google Scholar
12.Wooldridge, JM. Introductory Econometrics: A Modern Approach. Mason, OH: Thomson South-Western; 2003.Google Scholar
13.Curtis, LH, Hammill, BG, Eisenstein, EL, Kramer, JM, Anstrom, KJ. Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care 2007;45(10Suppl 2): S103–S107.Google Scholar
14.Hirano, K, Imbens, GW. Estimation of causal effects using propensity score weighting: an application to data on right heart catheterization. Health Serv Outcomes Res Methodol 2001;2:259–278.Google Scholar
15.Rosenbaum, PR, Rubin, DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70:41–55.Google Scholar
16.Rosenbaum, PR, Rubin, DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985;39:33–38.Google Scholar
17.Carmeli, Y, Eliopoulos, G, Mozaffari, E, Samore, M. Health and economic outcomes of vancomycin-resistant enterococci. Arch Intern Med 2002;162:2223–2228.CrossRefGoogle ScholarPubMed
18.Webb, M, Riley, LW, Roberts, RB. Cost of hospitalization for and risk factors associated with vancomycin-resistant Enterococcus faecium infection and colonization. Clin Infect Dis 2001;33:445-152.CrossRefGoogle ScholarPubMed
19.Bhorade, SM, Christenson, J, Pohlman, AS, Arnow, PM, Hall, JB. The incidence of and clinical variables associated with vancomycin-resistant enterococcal colonization in mechanically ventilated patients. Chest 1999;115:1085–1091.CrossRefGoogle ScholarPubMed
20.Lodise, TP, McKinnon, PS, Tarn, VH, Rybak, MJ. Clinical outcomes for patients with bacteremia caused b. vancomycin-resistant Enterococcus in a level 1 trauma center. Clin Infect Dis 2002;34:922–929.CrossRefGoogle Scholar
21.Linden, PK, Pasculle, AW, Manez, R, et al. Differences in outcomes for patients with bacteremia due to vancomycin-resistant Enterococcus faecium or vancomycin-susceptible E. faecium. Clin Infect Dis 1996;22:663–670.CrossRefGoogle ScholarPubMed
22.DiazGranados, CA, Jernigan, JA. Impact of vancomycin resistance of mortality among patients with neutropenia and enterococcal bloodstream infection. J Infect Dis 2005;191:588–595.CrossRefGoogle ScholarPubMed
23.Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infections of patient outcomes in the ICU setting. Chest 2000;118:146–155.CrossRefGoogle ScholarPubMed
24.Vergis, EN, Hayden, MK, Chow, JW, et al. Determinants of vancomycin resistance and mortality rates in enterococcal bacteremia: a prospective multicenter study. Ann Intern Med 2001;135:484–492.Google Scholar
25.lezzoni, LI. Coded data from administrative sources. In: lezzoni, LI, ed. Risk Adjustment for Measuring Health Care Outcomes. Chicago, IL: Health Administration Press; 2009:83–138.Google Scholar
26.Virnig, BA, McBean, M. Administrative data for public health surveillance and planning. Annu Rev Public Health 2001;22:213–230.CrossRefGoogle ScholarPubMed
27.Malenka, DJ, McLerran, D, Roos, N, Fisher, ES, Wennberg, JE. Using administrative data to describe casemix: a comparison with the medical record. J Clin Epidemiol 1994;47:1027–1032.CrossRefGoogle ScholarPubMed
28.Newschaffer, CJ, Bush, TL, Penberthy, LT. Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data. J Clin Epidemiol 1997;50:725–733.Google Scholar
29.Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals (published correction appears in Infect Control Hosp Epidemiol 2009;30:815). Infect Control Hosp Epidemiol 2008;29(Suppl 1):S22-S30.Google Scholar
30.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Healthcare Infection Control Practices Advisory Committee. Management of multidrug-re-sistant organisms in healthcare settings. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed March 2, 2009.Google Scholar