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Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study.

Abstract：

OBJECTIVES:To estimate the clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan. DESIGN:Retrospective cohort study. SETTING:Nationwide Taiwanese population in the National Health Insurance Research Database and the Taiwan Nosocomial Infections Surveillance (2007-2015) dataset. PARTICIPANTS:The first episodes of intensive care unit-acquired bloodstream infections in patients ≥20 years of age in the datasets. Propensity score-matching (1:2) of demographic data, comorbidities and disease severity was performed to select a comparison cohort from a pool of intensive care unit patients without intensive care unit-acquired infections from the same datasets. PRIMARY AND SECONDARY OUTCOME MEASURES:The mortality rate, length of hospitalisation and healthcare cost. RESULTS:After matching, the in-hospital mortality of 14 234 patients with intensive care unit-acquired bloodstream infections was 44.23%, compared with 33.48% for 28 468 intensive care unit patients without infections. The 14-day mortality rate was also higher in the bloodstream infections cohort (4323, 30.37% vs 6766 deaths, 23.77%, respectively; p<0.001). Furthermore, the patients with intensive care unit-acquired bloodstream infections had a prolonged length of hospitalisation after their index date (18 days (IQR 7-39) vs 10 days (IQR 4-21), respectively; p<0.001) and a higher healthcare cost (US$16 038 (IQR 9667-25 946) vs US$10 372 (IQR 6289-16 932), respectively; p<0.001). The excessive hospital stay and healthcare cost per case were 12.69 days and US$7669, respectively. Similar results were observed in subgroup analyses of various WHO's priority pathogens and Candida spp. CONCLUSIONS:Intensive care unit-acquired bloodstream infections in critically ill patients were associated with increased mortality, longer hospital stays and higher healthcare costs.

journal_name

BMJ Open

journal_title

BMJ open

authors

Wang YC,Shih SM,Chen YT,Hsiung CA,Kuo SC

doi

10.1136/bmjopen-2020-037484

subject

Has Abstract

pub_date

2020-11-26 00:00:00

pages

e037484

issue

issn

2044-6055

pii

bmjopen-2020-037484

journal_volume

pub_type

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Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study.