Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. 868-872 (doi:10.1542/peds.2004-0256)
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Attributable Cost of Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients

Alexis M. Elward, MD*, Christopher S. Hollenbeak, PhD{ddagger}, David K. Warren, MD§ and Victoria J. Fraser, MD§

Departments of * Pediatrics
§ Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
{ddagger} Departments of Surgery and Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania

Objective. To determine the attributable cost of nosocomial primary bloodstream infections (BSIs) in PICU patients.

Methods. A prospective cohort study was conducted of the PICU of the St Louis Children's Hospital, a 235-bed academic tertiary care center. All patients who were admitted to the PICU were included unless they met the following exclusion criteria: age >18 years, death within 24 hours of PICU admission, admission to the NICU service. Total and direct medical costs of PICU and hospital stay for patients with and without nosocomial primary BSI were measured.

Results. Fifty-seven children developed 65 episodes of primary BSIs during their PICU stay. The rate of BSI in this population was 13.8 per 1000 central venous catheter days. In multiple linear regression analysis, severity of illness as measured by the admission Pediatric Risk of Mortality Score III, congenital heart disease, underlying lung disease, ventilator days, transplant (solid organ and bone marrow), and nosocomial primary BSI were independent predictors of PICU direct costs. The direct cost of PICU admission for patients with nosocomial primary BSI was $45 615 and for the patients without primary BSI was $6396.

Conclusions. After controlling for age, severity of illness, underlying disease, and ventilator days, we found that the direct cost of PICU admission attributable to nosocomial primary BSI was $39 219. The prevention of these infections through specific interventions is likely to be cost-effective.

Key Words: cost • nosocomial • bloodstream infection • pediatric intensive care

Abbreviations: BSI, bloodstream infection • PRISM, Pediatric Risk of Mortality Score III

Accepted Aug 16, 2004.


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