Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality

Surgical intensive care unit (SICU) patients who contract bacterial bloodstream infections appear to remain in the SICU longer and to be at a significantly increased risk of death. The mortality rate, length of stay in the SICU and cost of care were evaluated for 86 SICU patients who developed bacterial bloodstream infections and 86 SICU patients who did not. Bloodstream infections occurred at a rate of 2.7 for each 100 admissions. Half of those who developed bloodstream infections in the SICU died compared with only 15% of SICU patients who did not develop infections. Bloodstream infections accounted for a 35% increase in deaths among those studied. Those who developed infections were hospitalized for a median of 40 days compared to a median of 26 days for those who did not develop infections. Hospital costs attributed to infections among those that survived averaged $40,890 for each patient. Overall costs averaged $46,929 for those that did not develop infections and $87,819 for those that did.
Objective.--To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients. Design.--Pairwise-matched (1:1) case-control study. Setting.--Surgical intensive care unit (SICU) in a tertiary health care institution. Patients.-all patients admitted in the SICU between July 1, 1988, and June 30, 1990, were eligible. Cases were defined as patients with nosocomial bloodstream infection; controls were selected according to matching variables in a stepwise fashion. Methods.--Matching variables were primary diagnosis for admission, age, sex, length of stay before the day of infection in cases, and total number of discharge diagnoses. Matching was successful for 89% of the cohort; 86 matched case-control pair's were studied. Main Outcome Measures.--Crude and attributable mortality, excess length of hospital and SICU stay, and overall costs. Results.--Nosocomial bloodstream infection complicated 2.67 per 100 admissions to the SICU during the study period. The crude mortality rates from cases and controls were 50% and 15%, respectively (P