551. Impact of Nosocomial Blood Stream Infection (BSI) in the Elderly on Length of Stay and Hospital Cost
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Few published data exist regarding the impact of BSI on length of stay (LOS) and hospital charges among older adults. The objective of the study was to quantify the impact of nosocomial BSI on LOS and hospital charges in older patients.
Methods: A matched outcomes study was conducted at 8 hospitals from Jan 1994 - June 2002. Patients greater than 64 years old with nosocomial BSI (occurring 48 hours after admission) were identified. An elderly control without BSI was matched to each case by hospital, length of stay before BSI, hospital ward and calendar time. Variables were collected from the patient chart, including LOS and hospital charges accrued during the 90 days after initial hospitalization. Linear regression was used to calculate LOS and hospital charges attributable to BSI.
Results: 830 BSI cases and 830 controls were analyzed. The mean age of patients was 74.4 years; 50.8% were male and 69.9% were white. 416 (50.1 %) cases and 422 (51.3%) controls had a Charlson score > 2. Impaired functional status was reported in 426 (52%) cases and 460 (56%) controls. BSI was categorized as primary (eg. catheter-associated) in 672 (81%) cases. The most common BSI pathogen was Staphylococcus aureus: 287 (34.6%) (66.9 % were methicillin-resistant). The mean LOS for cases and controls were 29.2 and 20.2 days respectively (p<0.001). The mean hospital charges were available for 622 cases and 597 controls. Cases had mean hospital charges of 102,276 dollars and controls had mean hospital charges of 69,690 dollars (p<0.001). In multivariate analysis, the mean LOS attributable to BSI was 10 days (95% CI: 8.4~13.0) and the mean hospital charges attributable to BSI was 43,208 dollars (95% CI: 30,663~58,540).
Conclusion: BSI was associated with severe adverse outcomes in older hospitalized adults. Because the majority of BSI were catheter-associated, interventions targeting prevention of catheter-related BSI might have a large beneficial impact on older adults.
Deverick Anderson, MD MPH1, Ting-Yi Chen, MD2, Yong Choi, RN3, Teena Chopra, MD2, Keith Kaye, MD, MPH, FIDSA, FSHEA4, Kenneth Schmader, MD, Rick Sloane, MD1 and  T. Chen, None..
D. J. Anderson, None..
T. Chopra, None..
Y. Choi, None..
R. Sloane, None..
K. Schmader, None..
K. Kaye, None., (1)Duke University Medical Center, Durham, NC, (2)Detroit Medical Center, Detroit, MI, (3)Duke University Medical Center, North Carolina, NC, (4)Detroit Medical Center, Wayne State University, Detroit, MI