Patient-level cost analysis of intensive care unit-acquired infections: a prospective cohort study

Abstract

Background

Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length of stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, and were performed in a small number of centres or only in high-income countries.

Aim

To assess the incremental cost of intensive care unit (ICU) HAIs in a large cohort of critically ill patients in a platform collaborative study.

Methods

A prospective cohort study was performed in ten Brazilian ICUs selected from a collaborative platform study (IMPACTO MR). All patients aged ≥18 years admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days were included. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. A propensity score matching method was used to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and multidrug-resistant (MDR) HAIs.

Findings

The study included 7953 patients, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs ($19,642 (IQR: 12,884–35,134) vs 6,086 (IQR: 3268–12,550); P < 0.001). Patients with VAP, CLABSI, and CAUTI, but not with MDR-HAIs, also had higher total ICU costs.

Conclusion

HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.