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Effect of Nosocomial Vancomycin-Resistant Enterococcal Bacteremia on Mortality, Length of Stay, and Costs

Published online by Cambridge University Press: 02 January 2015

Xiaoyan Song*
Affiliation:
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins School of Medicine, Baltimore, Maryland
Arjun Srinivasan
Affiliation:
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins School of Medicine, Baltimore, MarylandDepartment of Antibiotic Management, The Johns Hopkins School of Medicine, Baltimore, Maryland
David Plaut
Affiliation:
Department of Casemix Information Management, The Johns Hopkins School of Medicine, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Hospital Epidemiology and Infection Control, The Johns Hopkins School of Medicine, Baltimore, MarylandDivision of Infectious Diseases, The Johns Hopkins School of Medicine, Baltimore, MarylandDepartment of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Department of Hospital Epidemiology and Infection Control,The Johns Hopkins Hospital, Carnegie 288, 600 N. Wolfe Street, Baltimore, MD 21287

Abstract

Objective:

To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it.

Design:

A population-based, matched, historical cohort study.

Setting:

A 1,025-bed, university-based teaching facility and referral hospital.

Patients:

Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000.

Results:

The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, $77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and $81,208, respectively.

Conclusion:

Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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