298. Comparison of hospital charges associated with healthcare-associated infections in neonatal intensive care units
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Healthcare-associated infections (HAIs) increase morbidity and mortality as well as healthcare costs of infants in the neonatal ICU.  Studies have shown that bloodstream infections (BSIs) caused by antimicrobial resistant organisms (AMROs) result in increased costs when compared to BSIs caused by non-AMROs.  However, this has not been well studied in the NICU population. We hypothesized that HAIs, including BSIs caused by AMROs, would be associated with increased hospital costs.

Methods: We conducted a prospective study in 4-level III NICUs from May 2009 to April 2012.  Eligible infants were < 7 days of age at NICU admission and hospitalized ≥4 days. Infants were grouped by the presence or absence of HAIs (Table).  HAIs were defined as infections diagnosed by attending neonatologists and treated with intravenous antibiotics.  Susceptibility breakpoints from the 2012 Clinical Laboratory Standards Institute were used. AMROs included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and gram negative bacilli resistant to gentamicin, piperacillin-tazobactam, 3rd/4thgeneration cephalosporin agents, and carbapenem agents.  Charge data for each infant’s NICU hospitalization were collected from available resources.  Student t- test and linear regression were used, when appropriate.

Results: When controlling for study site, sex, race, birth weight, surgery and other HAIs, the mean NICU charge for infants with BSIs (Group 1) was significantly higher than for those with non-BSI HAIs (Group 2) [p=0.0001] or no HAIs (Group 3)[p<0.0001]. The mean charges for infants with an AMRO BSI (n=88) vs. non-AMRO BSI (n=95) were comparable ($542,762 vs. $584,140, respectively, p = 0.54).

Conclusion: Neonates who have a BSI during their hospitalization have greater hospital charges when compared to those with other HAIs or no HAIs.  In this population, AMRO causing BSIs did not appear to affect hospital charges.  Reduction of HAIs could reduce healthcare costs.

Table: Charges associated with different types of HAIs in neonatal ICU


Group

Infants (n)

BSI

Non-BSI HAI

Mean Charge (USD)

Charge Range

(USD)

Total Charge (USD)

(1)    BSI

183

+

+/-

$564,243

$9285 - 3,082,211

$103,256,386

(2)    Non-BSI HAI

884

-

+

$367,291

$1297 - 37,774,012

$324,685,550

(3)    No HAI

4797

-

-

$98,583

$168 - 1,322,419

$472,901,826

Meghan Murray, MPH1, Yu-Hui Ferng, MPA1, Sameer Patel, MD, MPH2,3, Luis Alba, BS4, Frederick Mis, PhD5, Theoklis Zaoutis, MD, MSCE6, Susan E. Coffin, MD, MPH7, Kateri Leckerman, MS8, Priya Prasad, MPH8, David Paul, MD9, Kelly Gray, BSN, RN9, Patricia DeLaMora, MD10, Jeffrey Perlman, MB ChB11, Haomiao Jia, PhD12, Sherry Glied, PhD13, Elaine Larson, PhD, RN, FIDSA, FSHEA1 and Lisa Saiman, MD, MPH, FSHEA14, (1)School of Nursing, Columbia University Medical Center, New York, NY, (2)Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (3)Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, (4)Pediatrics, COLUMBIA UNIVERSITY MEDICAL CENTER, New York, NY, (5)Clinical Information Support Services, NewYork-Presbyterian, New York, NY, (6)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA, (7)Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (8)The Children's Hospital of Philadelphia, Philadelphia, PA, (9)Christiana Neonatal Associates, Christiana Care Health System, Newark, DE, (10)Pediatrics, Weill Cornell Medical College, New York, NY, (11)Pediatrics, Weill Cornell Medical Center, New York, NY, (12)Biostatistics, Columbia University Mailman School of Public Health, New York, NY, (13)Health Policy & Management, Columbia University Mailman School of Public Health, New York, NY, (14)Columbia University College of Physicians & Surgeons, New York, NY

Disclosures:

M. Murray, None

Y. H. Ferng, None

S. Patel, None

L. Alba, None

F. Mis, None

T. Zaoutis, None

S. E. Coffin, None

K. Leckerman, None

P. Prasad, None

D. Paul, None

K. Gray, None

P. DeLaMora, None

J. Perlman, None

H. Jia, None

S. Glied, None

E. Larson, None

L. Saiman, None

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