ATTRIBUTABLE COST AND LENGTH OF STAY OF NOSOCOMIAL GRAM-NEGATIVE BACTERIA CULTURES [Epidemiology and Surveillance]

Introduction: Few studies have estimated the excess inpatient cost due to nosocomial Gram-negative bacteria (GNB) cultures and those that do are often subject to time-dependent bias. Our objective was to generate estimates of the attributable cost of the underlying infections associated with nosocomial cultures using a unique inpatient cost dataset from the US Department of Veterans Affairs that allowed us to reduce time-dependent bias.

Methods: Our study included data from inpatient admissions between 10/1/2007 and 11/30/2010. Nosocomial GNB positive cultures were defined as positive clinical cultures for Acinetobacter, Pseudomonas, or Enterobacteriaceae from 48 hours after admission to discharge. Positive cultures were further classified by site and their level of resistance. We conducted analyses using both a conventional approaches and an approach aimed at reducing the impact of time-dependent bias. In both instances, we used multivariable generalized linear models to compare the inpatient costs and LOS between patients with and without a nosocomial Gram-negative bacteria cultures.

Results: Of the 404,652 patients included in the conventional analysis, 12,356 had a nosocomial GNB positive culture. The excess cost of nosocomial GNB positive cultures was significant regardless of specific pathogen, site, or resistance level. Estimates generated using the conventional analysis approach were 32.0% - 131.2% higher in magnitude than those generated using an approach to reduce time-dependent bias.

Conclusion: These results are important because they underscore the high financial burden attributable to these infections and provide a baseline that can be used to assess the impact of improvements in infection control.

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