High Death Rate from Hospital Aquired Infections

Byron's Comments:

At the source of this problem is the rampant overuse of antibiotics.

Study Title:

Clinical and Economic Outcomes Attributable to Health Care–Associated Sepsis and Pneumonia

Study Abstract:

Background Health care–associated infections affect 1.7 million hospitalizations each year, but the clinical and economic costs attributable to these infections are poorly understood. Reliable estimates of these costs are needed to efficiently target limited resources for the greatest public health benefit.

Methods Hospital discharge records from the Nationwide Inpatient Sample database were used to identify sepsis and pneumonia cases among 69 million discharges from hospitals in 40 US states between 1998 and 2006. Community-acquired infections were excluded using criteria adapted from previous studies. Because these criteria may not exclude all community-acquired infections, outcomes were examined separately for cases associated with invasive procedures, which were unlikely to result from preexisting infections. Attributable hospital length of stay, hospital costs, and crude in-hospital mortality were estimated from discharge records using a multivariate matching analysis and a supplementary regression analysis. These models controlled for patient diagnoses, procedures, comorbidities, demographics, and length of stay before infection.

Results In cases associated with invasive surgery, attributable mean length of stay was 10.9 days, costs were $32 900, and mortality was 19.5% for sepsis; corresponding values for pneumonia were 14.0 days, $46 400, and 11.4%, respectively (P < .001). In cases not associated with invasive surgery, attributable mean length of stay, costs, and mortality were estimated to be 1.9 to 6.0 days, $5800 to $12 700, and 11.7% to 16.0% for sepsis and 3.7 to 9.7 days, $11 100 to $22 300, and 4.6% to 10.3% for pneumonia (P < .001).

Conclusion Health care–associated sepsis and pneumonia impose substantial clinical and economic costs.

From press release:

Pneumonia and blood-borne infections caught in U.S. hospitals killed 48,000 patients and cost $8.1 billion in 2006, according to a report released on Monday.

The study is one of the first to put a price tag on the widespread problem, which is worsening and which some experts say is adding to the growing cost of healthcare in the United States.

“In many cases, these conditions could have been avoided with better infection control in hospitals,” said Ramanan Laxminarayan of Resources for the Future, a think tank that sponsored the study.

Sepsis — a blood infection — killed 20 percent of patients who developed it after surgery, Laxminarayan and colleagues reported in the Archives of Internal Medicine.

They studied hospital discharge records from 69 million patients at hospitals in 40 U.S. states between 1998 and 2006, looking for two diagnoses — hospital-acquired pneumonia and sepsis.

Patients who developed sepsis after surgery had to stay in the hospital on average nearly 11 days extra, at a cost of $32,900 per patient, they found. And just under 20 percent of them died.

Pneumonia patients stayed an extra 14 days after surgery, at a cost of $46,400 and more than 11 percent of them died, the researchers found.

“That’s the tragedy of such cases,” said Anup Malani of the University of Chicago, who worked on the study.

“In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control and they can die.”

The researchers said that 1.7 million healthcare-associated infections are diagnosed every year.

Many are due to drug-resistant bacteria, such as methicillin resistant Staphylococcus aureus or MRSA, which cost more to treat because only a few drugs can work against them. These infections can also be caught outside hospitals and some studies show that such community-acquired infections are also on the rise.

One estimate from Pfizer Inc suggested that treating MRSA alone cost $4 billion a year.

Measures to prevent infection are simple and include careful handwashing, hygiene and screening patients when they check in. However, these measures are difficult to enforce, many studies have found.

Study Information:

Michael R. Eber; Ramanan Laxminarayan; Eli N. Perencevich; Anup Malani Clinical and Economic Outcomes Attributable to Health Care–Associated Sepsis and Pneumonia Arch Intern Med. 2010 February 170(4):347-353.
Center for Disease Dynamics, Economics, & Policy, Resources for the Future, Washington, DC.




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