Hospital-Acquired Infections Common and Costly

LONDON – Hospital-acquired infections occurred in more than one in four intensive care unit stays and increased the cost per stay by nearly $16,000, a retrospective analysis of data from a large U.S. hospital database revealed.

"The prevalence and burden of hospital-acquired infections in the ICU are high and clearly associated with a major economic impact," said Florence Joly, Pharm.D., of Sanofi R&D, France.

The study was conducted by Sanofi to inform the development of a new drug to combat hospital-associated infections (HAIs) including bloodstream infections, hospital-acquired pneumonia (HAP), and surgical site infections (SSIs). The data came from Premier Perspective, a large U.S. hospital database containing information from more than 700 hospitals and representing about 20% of all hospital discharges in the United States.

The analysis included 463,491 adults aged 18 years and older who were admitted in 2007 for a total of 511,815 ICU stays of more than 48 hours. The patients were 53% male and had a mean age of 64 years. A third (33%) had diabetes, 26% had a central venous catheter/central line, and 22% were on mechanical ventilation. Most of the patients (91.5%) had just one ICU stay, but 7% had two stays and 1.5% had three or more stays.

At least one HAI occurred in 27% of all ICU stays, including pneumonia in 17%, bloodstream infections in 14.5%, and SSIs in 1.5%. In addition, severe sepsis occurred in 40%, she reported at the European Congress of Clinical Microbiology and Infectious Diseases.

Length of stay (LOS) was 23 days for SSIs, at a cost of $59,905 per stay. For bloodstream infections, the stay was 18 days at $43,071 per stay, and for HAP, 15 days at $36,467/stay. Mortality was 25% for bloodstream infections, 17% for HAP, and 11% for SSIs. In total, the length of stay for all that involved HAI was 16 days at a cost of $37,539 per stay, compared with just 8 days at $21,541 per stay for those without HAI. Overall mortality rates were 19% with HAI vs. 4.5% without. All of the HAI/no HAI differences were highly statistically significant, she noted.

Similar results were found using data from 2008 and 2009.

"The increase in mortality rates and longer LOS findings as the drivers of higher ICU costs indicate the need for specific measures to reduce the prevalence of these major types of hospital-acquired infections," Dr. Joly concluded.

In a separate poster presentation by Dr. Caroline Amand-Bourdon, also of Sanofi R&D, the same database of 463,491 patients was analyzed for risk factors predicting HAI for just the first hospitalization per patient. In all, 26% of the patients (119,616) experienced a HAI, including 17% with pneumonia, 14% with a bloodstream infection, and 1% with an SSI. Compared with the 343,875 patients who did not have a HAI, patients who did were older (mean age 66 vs. 63 years) and had more device procedures, including central catheter placements (49% vs. 18%) and mechanical ventilation hookups (42% vs. 15%). The HAI patients were also more often admitted via the emergency department (71% vs. 56%).

Central catheter and mechanical ventilation were identified as the two main risk factors for HAI, with adjusted odds ratios of 3.4 and 2.8, respectively, Dr. Amand-Bourdon and her associates reported.

"These findings illustrate the changing nature of hospital inpatient populations over the years that are more vulnerable to HAI," according to the investigators.

Both Dr. Joly and Dr. Amand-Bourdon are employees of Sanofi, which funded and conducted the study.

LONDON – Hospital-acquired infections occurred in more than one in four intensive care unit stays and increased the cost per stay by nearly $16,000, a retrospective analysis of data from a large U.S. hospital database revealed.

"The prevalence and burden of hospital-acquired infections in the ICU are high and clearly associated with a major economic impact," said Florence Joly, Pharm.D., of Sanofi R&D, France.

The study was conducted by Sanofi to inform the development of a new drug to combat hospital-associated infections (HAIs) including bloodstream infections, hospital-acquired pneumonia (HAP), and surgical site infections (SSIs). The data came from Premier Perspective, a large U.S. hospital database containing information from more than 700 hospitals and representing about 20% of all hospital discharges in the United States.

The analysis included 463,491 adults aged 18 years and older who were admitted in 2007 for a total of 511,815 ICU stays of more than 48 hours. The patients were 53% male and had a mean age of 64 years. A third (33%) had diabetes, 26% had a central venous catheter/central line, and 22% were on mechanical ventilation. Most of the patients (91.5%) had just one ICU stay, but 7% had two stays and 1.5% had three or more stays.

At least one HAI occurred in 27% of all ICU stays, including pneumonia in 17%, bloodstream infections in 14.5%, and SSIs in 1.5%. In addition, severe sepsis occurred in 40%, she reported at the European Congress of Clinical Microbiology and Infectious Diseases.

Length of stay (LOS) was 23 days for SSIs, at a cost of $59,905 per stay. For bloodstream infections, the stay was 18 days at $43,071 per stay, and for HAP, 15 days at $36,467/stay. Mortality was 25% for bloodstream infections, 17% for HAP, and 11% for SSIs. In total, the length of stay for all that involved HAI was 16 days at a cost of $37,539 per stay, compared with just 8 days at $21,541 per stay for those without HAI. Overall mortality rates were 19% with HAI vs. 4.5% without. All of the HAI/no HAI differences were highly statistically significant, she noted.

Similar results were found using data from 2008 and 2009.

"The increase in mortality rates and longer LOS findings as the drivers of higher ICU costs indicate the need for specific measures to reduce the prevalence of these major types of hospital-acquired infections," Dr. Joly concluded.

In a separate poster presentation by Dr. Caroline Amand-Bourdon, also of Sanofi R&D, the same database of 463,491 patients was analyzed for risk factors predicting HAI for just the first hospitalization per patient. In all, 26% of the patients (119,616) experienced a HAI, including 17% with pneumonia, 14% with a bloodstream infection, and 1% with an SSI. Compared with the 343,875 patients who did not have a HAI, patients who did were older (mean age 66 vs. 63 years) and had more device procedures, including central catheter placements (49% vs. 18%) and mechanical ventilation hookups (42% vs. 15%). The HAI patients were also more often admitted via the emergency department (71% vs. 56%).

Central catheter and mechanical ventilation were identified as the two main risk factors for HAI, with adjusted odds ratios of 3.4 and 2.8, respectively, Dr. Amand-Bourdon and her associates reported.

"These findings illustrate the changing nature of hospital inpatient populations over the years that are more vulnerable to HAI," according to the investigators.

Both Dr. Joly and Dr. Amand-Bourdon are employees of Sanofi, which funded and conducted the study.

LONDON – Hospital-acquired infections occurred in more than one in four intensive care unit stays and increased the cost per stay by nearly $16,000, a retrospective analysis of data from a large U.S. hospital database revealed.

"The prevalence and burden of hospital-acquired infections in the ICU are high and clearly associated with a major economic impact," said Florence Joly, Pharm.D., of Sanofi R&D, France.

The study was conducted by Sanofi to inform the development of a new drug to combat hospital-associated infections (HAIs) including bloodstream infections, hospital-acquired pneumonia (HAP), and surgical site infections (SSIs). The data came from Premier Perspective, a large U.S. hospital database containing information from more than 700 hospitals and representing about 20% of all hospital discharges in the United States.

The analysis included 463,491 adults aged 18 years and older who were admitted in 2007 for a total of 511,815 ICU stays of more than 48 hours. The patients were 53% male and had a mean age of 64 years. A third (33%) had diabetes, 26% had a central venous catheter/central line, and 22% were on mechanical ventilation. Most of the patients (91.5%) had just one ICU stay, but 7% had two stays and 1.5% had three or more stays.

At least one HAI occurred in 27% of all ICU stays, including pneumonia in 17%, bloodstream infections in 14.5%, and SSIs in 1.5%. In addition, severe sepsis occurred in 40%, she reported at the European Congress of Clinical Microbiology and Infectious Diseases.

Length of stay (LOS) was 23 days for SSIs, at a cost of $59,905 per stay. For bloodstream infections, the stay was 18 days at $43,071 per stay, and for HAP, 15 days at $36,467/stay. Mortality was 25% for bloodstream infections, 17% for HAP, and 11% for SSIs. In total, the length of stay for all that involved HAI was 16 days at a cost of $37,539 per stay, compared with just 8 days at $21,541 per stay for those without HAI. Overall mortality rates were 19% with HAI vs. 4.5% without. All of the HAI/no HAI differences were highly statistically significant, she noted.

Similar results were found using data from 2008 and 2009.

"The increase in mortality rates and longer LOS findings as the drivers of higher ICU costs indicate the need for specific measures to reduce the prevalence of these major types of hospital-acquired infections," Dr. Joly concluded.

In a separate poster presentation by Dr. Caroline Amand-Bourdon, also of Sanofi R&D, the same database of 463,491 patients was analyzed for risk factors predicting HAI for just the first hospitalization per patient. In all, 26% of the patients (119,616) experienced a HAI, including 17% with pneumonia, 14% with a bloodstream infection, and 1% with an SSI. Compared with the 343,875 patients who did not have a HAI, patients who did were older (mean age 66 vs. 63 years) and had more device procedures, including central catheter placements (49% vs. 18%) and mechanical ventilation hookups (42% vs. 15%). The HAI patients were also more often admitted via the emergency department (71% vs. 56%).

Central catheter and mechanical ventilation were identified as the two main risk factors for HAI, with adjusted odds ratios of 3.4 and 2.8, respectively, Dr. Amand-Bourdon and her associates reported.

"These findings illustrate the changing nature of hospital inpatient populations over the years that are more vulnerable to HAI," according to the investigators.

Both Dr. Joly and Dr. Amand-Bourdon are employees of Sanofi, which funded and conducted the study.