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J Am Geriatr Soc. 2014 Feb;62(2):306-11. doi: 10.1111/jgs.12634. Epub 2014 Jan 17.

Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults.

Author information

1
Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, Michigan, Israel.

Abstract

OBJECTIVES:

To quantify the effect of nosocomial bloodstream infection (BSI) on older adults, including mortality, length of stay (LOS), and costs attributed to BSI.

DESIGN:

Retrospective cohort study.

SETTING:

Eight acute care hospitals (7 community hospitals and 1 tertiary university-affiliated facility) belonging to the Duke Infection Control Outreach Network (DICON) from the states of North Carolina and Virginia.

PARTICIPANTS:

Elderly patients over 65 years of age.

MEASUREMENTS:

A multistate, multicenter, matched, retrospective cohort study was conducted from January 1994 through June 2002 in eight hospitals from the Southern-Central United States. Patients aged >65 years with nosocomial BSI were enrolled. Controls without bloodstream infection were matched to cases. Outcomes during the 90-day period following hospital discharge were evaluated to determine the association between BSI and mortality, hospital costs, and LOS.

RESULTS:

Eight-hundred thirty cases and 830 matched controls were identified, all with a mean age of 74.4 years. Among cases, 81% of BSIs were central line-associated and Staphylococcus aureus was the most common pathogen accounting for 34.6% of infections (2/3 were methicillin resistant). The mortality rate of cases was 49.4%, compared to 33.2% for controls (OR = 2.1, P < .001), LOS was 29.2 days for cases and 20.2 days for controls (P < .001), and hospital charges were $102,276 for cases compared to $69,690 for controls (P < .001). The mean LOS and mean costs attributable to BSI were 10 days and $43,208, respectively.

CONCLUSION:

Nosocomial BSI in older adults was significantly associated with increases in 90-day mortality, increased LOS, and increased costs of care. Preventive interventions to eliminate nosocomial BSIs in older adults would likely be cost effective.

KEYWORDS:

bacteremia; blood-stream infections; elderly; hospital acquired; methicillin-resistant Staphylococcus aureus; outcome

PMID:
24438554
PMCID:
PMC4037885
DOI:
10.1111/jgs.12634
[Indexed for MEDLINE]
Free PMC Article

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