Healthcare-associated infections (HAI) are among the most common preventable health adverse event, associated with significant burden globally. Limited data on HAI costs in lower and middle-income countries is available. The aim of this study is to assess the cost, additional length-of-stay (LOS) and extra-mortality of HAI in the Latin American and Caribbean (LAC) Region.

We searched Medline/PubMed, Embase, Web of Science, Lilacs, Cochrane, National Health Service Economic Evaluation Database, Centre for Reviews and Dissemination, EconLit, and gray literature published in any language without restriction of date till July 2017. We included observational studies addressing the outcomes of interest, in which hospitalized patients with HAI are compared to those without HAI. The following study designs were included: quasi-experimental, controlled before-after, prospective and retrospective comparative cohort, case-control, and cross-sectional studies. We considered the following HAI-sites: surgical site infections (SSI), catheter-associated urinary-tract infections (CA-UTI), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLA-BSI), as well as cross-infection (CI). Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Reported costs were converted to USD considering official exchange rates.

We identified 4,339 citations. After removing duplicates, a total of 3,029 citations were screened for eligibility. A total of 87 studies from 17 countries were included. The majority (27.4 percent) reported on VAP, followed by CLA-BSI (21.2 percent), SSI (16.4 percent), and CA-UTI (14.4 percent). Most studies (46.7 percent) reported on incremental LOS, with an average of 14.8 days (range 0.9-49 days). Costs were reported by 25 percent of studies, with average incremental costs of USD 3,460 (range 49-12,155). Average extra-mortality of 15.6 percent (range -2.8-45.2 percent) was reported by 12.6 percent of studies.

Available evidence from the LAC Region reports significant economic burden of HAI. This information will be useful for cost-effectiveness analysis of interventions aimed at reducing HAI economic and health burden.