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In-hospital mortality quadruples in ICU patients with HAI

A recent study presented at the 22nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in London, England, in April, suggests that in-hospital mortality in ICU patients with hospital-acquired infections (HAI) was four times higher than in those without HAI.

The study, which was led by Florence Joly, PharmD, from global evidence and value development at Sanofi in Paris, France, analyzed data from an American hospital database. The team used the Premier Prospective hospital database, which covers 20% of hospital discharges in the United States, to gather evidence from adults 18 years or older with an ICU stay of at least 48 hours in 2007.

"A device, namely a central catheter [odds ratio (OR), 3.4] or mechanical ventilation [OR, 2.8], trebled the risk of having a HAI, including bloodstream infection, nosocomial pneumonia, and surgical-site infection," notes Dr. Joly. An even higher risk was associated with patients coming from the emergency room and those patients older than 75 years of age.

Over a one-year period, hospital-acquired pneumonia was associated with 16.9% of ICU stays, ventilator-acquired pneumonia with 3.7%, bloodstream infection with 14.5%, and surgical-site infection with 1.5%. Overall, 26.7% of ICU stays were associated with at least one HAI, which is three times higher than the general infection rate in the hospital.

"We found that hospital-acquired infection triggered a significant extra 7.5 days in intensive care," reported Dr. Joly. "The longest stay was observed for surgical-site infections, with a mean of 23.4 days."

So, the team conducted a cost analysis. Based on direct variable costs and fixed overhead costs, Dr. Joly reported these infections cost an extra $16,000 per ICU stay, from $21,500 for a patient without a HAI to $37,500 for a patient with a HAI.

According to Christian Brun-Buisson, MD, PhD, professor of medicine and intensive care at Université Paris-Est Créteil, director of the medical intensive care unit at Hôpital Henri Mondor in Créteil, France, and moderator of the session at ECCMID, "These data ... confirm the current burden of HAI on ICU patients and the role of known risk factors, mainly invasive devices, to which this population is highly exposed, although in this study, the exposure rate to mechanical ventilation is unusually low."

Although he cautioned when interpreting the study’s outcomes, Dr. Brun-Buisson notes that, "Limiting exposure to devices is one way to reduce the risk of HAI..., as is the development of devices less prone to colonization."

Whatever the interpretation, Dr. Joly states, "We wanted to get a better idea of the burden of disease and infection — especially in the ICU, where these infections represent a real challenge — and the economic impact incurred. We wanted to know the potential impact of a preventative intervention on these infections."