Major Article
The attributable cost and length of hospital stay because of nosocomial pneumonia in intensive care units in 3 hospitals in Argentina: A prospective, matched analysis

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Background

No information is available on the financial impact of nosocomial pneumonia in Argentina. To calculate the cost of nosocomial pneumonia in intensive care units, a 5-year, matched cohort study was undertaken at 3 hospitals in Argentina.

Setting

Six adult intensive care units (ICU).

Methods

Three hundred seven patients with nosocomial pneumonia (exposed) and 307 patients without nosocomial pneumonia (unexposed) were matched for hospital, ICU type, year admitted to study, length of stay more than 7 days, sex, age, antibiotic use, and average severity of illness score (ASIS). The patient's length of stay (LOS) in the ICU was obtained prospectively in daily rounds, the cost of a day was provided by the hospital's finance department, and the cost of antibiotics prescribed for nosocomial pneumonia was provided by the hospital's pharmacy department.

Results

The mean extra LOS for 307 cases (compared with controls) was 8.95 days, the mean extra antibiotic defined daily doses (DDD) was 15, the mean extra antibiotic cost was $996, the mean extra total cost was $2255, and the extra mortality was 30.3%.

Conclusions

Nosocomial pneumonia results in significant patient morbidity and consumes considerable resources. In the present study, patients with nosocomial pneumonia had significant prolongation of hospitalization, cost, and a high extra mortality. The present study illustrates the potential cost savings of introducing interventions to reduce nosocomial pneumonia. To our knowledge, this is the first study evaluating this issue in Argentina.

Section snippets

Setting

The study was conducted in 3 medical centers in Buenos Aires, Argentina. Each center has an infection control team composed of a medical doctor with formal education and background in internal medicine, infectious diseases, and hospital epidemiology and an infection control nurse.6

Hospital A is a public 250-bed hospital situated in the province of Buenos Aires with 1 medical/surgical ICU (10 beds) and 1 coronary ICU (10 beds). Hospital B is a private 150-bed hospital situated in the province of

Results

During the study period (July 1998 to June 2002), 7230 adult patients were admitted to the study ICUs, and 419 (5.79%) were found to have nosocomial pneumonia.

Three hundred seven patients with nosocomial pneumonia had a LOS of 7 days or more and were incorporated into the analysis. Matching for more than 7 days of ICU stay, hospital, year of admission, type of ICU, sex, age, and average severity of illness score at admission was done. After matching for the 7 described characteristics, we chose

Discussion

NP is the leading cause of death from hospital-acquired infection; the incidence in ICUs varies from 7% to 40% of patients.4 Critically ill patients often require prolonged mechanical ventilation, which is the most important risk factor for NP.1 Several recent studies have found that nosocomial infections are emerging as an important problem in many developing countries.12, 13, 14, 15, 16, 17, 18 When infection, including NP, does occur, studies have repeatedly demonstrated an increased length

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