Increased Resource Use Associated With Catheter-Related Bloodstream Infection in the Surgical Intensive Care Unit

Hypothesis Catheter-related bloodstream infection (CRBSI) in critically ill surgical patients with prolonged intensive care unit (ICU) stays is associated with a significant increase in health care resource use. Design Prospective cohort study. Setting Surgical ICU at a large tertiary care center. Patients Critically ill surgical patients (N = 260) with projected surgical ICU length of stay greater than 3 days. Interventions Central venous catheters were cultured for clinical suspicion of infection. Main Outcome Measures Increases in total hospital cost, ICU cost, hospital days, and ICU days attributable to CRBSI were estimated using multiple linear regression after adjusting for demographic factors and severity of illness (APACHE III Apache Physiology and Chronic Health Evaluation III score). Results The incidence of CRBSI per 1000 catheter-days was 3. 6 episodes (95% confidence interval CI, 2. 1-5. 8 episodes). Microbiologic isolates were Gram-positive bacteria in 75%, Gram-negative bacteria in 20%, and yeast in 5%. After adjusting for demographic factors and severity of disease, CRBSI was associated with an increase of 56 167 (95% CI, 11 523-165 735;P=. 001) (in 1998 dollars) in total hospital cost, an increase of 71 443 (95% CI, 11 960-195 628;PConclusions For critically ill surgical patients, CRBSI is associated with a profound increase in resource use. Prevention, early diagnosis, and intervention for CRBSI might result in cost savings in this high-risk population.