Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study

Table 1 Demographic data of the groups with and without hospital acquired infections

Features	HAI (n = 76)	No HAI (n = 420)	P value
Age, mean (SD), (yr)	39.4 (16.2)	42.9 (16.5)	0.04
Male:female	46:30	241:179	0.70
APACHE II score, mean (SD)	14.01 (4.7)	13.9 (6.0)	0.58
Diagnosis n (%)
Sepsis (including scrub typhus)	27 (35.5)	195 (46.4)
Deliberate self-harm	30 (39.4)	99 (23.6)
Cardiac	4 (5.3)	34 (8.1)	0.11
Acute respiratory distress syndrome	5 (6.6)	28 (6.7)
Neurological	6 (7.9)	43 (10.2)
Others	4 (5.3)	21 (5.0)

Data not available for 3 patients. HAI: Hospital acquired infection; APACHE: Acute physiology and chronic health evaluation; SD: Standard deviation.

Table 2 Impact of hospital-acquired infections on outcomes

Outcome	HAI (n = 76)	No HAI (n = 420)	P value
ICU length of stay, mean (SD), (d)	13.4 (7.0)	6.7 (4.5)	< 0.01
Hospital stay, mean (SD), (d)	21.8 (13.9)	12.4 (8.2)	< 0.001
In-hospital mortality	31.60%	27.20%	0.49
Mortality with VAP1	26%	27.2%2	1.0
Mortality due to BSI1	37%	27.2%2	0.24
CAUTI mortality1	33%	27.2%2	1.0

¹Total number of patients with VAP was 50, BSI 35 and CAUTI 3; the total number of patients with individual infections exceed 76 since 10 patients had more than one infection source;

²Indicates patients who had no HAI during the entire course of intensive care stay; thus in the analysis for VAP, those with BSI or CAUTI were excluded from the no HAI group and for BSI those with VAP and CAUTI were excluded from the no HAI group. Data available only on 496 patients. VAP: Ventilator associated pneumonia; BSI: Blood stream infection; CAUTI: Catheter associated urinary tract infection; SD: Standard deviation; HAI: Hospital acquired infection.

Table 3 Comparison of overall cost between those with infection and those without infection

Type	HAI (n = 76)	No HAI1 (n = 420)	Cost difference	P value
Mean (SD) cost (INR)
Any infection	226398 (226268)	115058 (93754)	111340	< 0.0001
VAP	235350 (253421)	115058 (93754)	120292	< 0.001
BSI	283887 (341916)	115058 (93754)	168829	< 0.001
CAUTI	190059 (34096)	115058 (93754)	155963	0.05
Median (IQR) cost (INR)
Any infection	180469 (140030-237525)	92875 (57243-139104)	87594	< 0.0001
VAP	182991 (133038-238952)	92875 (57243-139104)	90116	< 0.0001
BSI	170753 (141788-238650)	92875 (57243-139104)	77878	< 0.0001
CAUTI	173085 (155818-190352)	92875 (57243-139104)	80210	0.06

¹The cost of no HAI is the same for all sub-categories of analysis based on source of infection since patients who developed any infection were not included in the “no HAI” group. At the time of the study, 1 USD = INR 61. Values in parenthesis indicate standard deviation. INR: Indian rupees; HAI: Hospital acquired infection; VAP: Ventilator associated pneumonia; BSI: Blood stream infection; CAUTI: Catheter associated urinary tract infection; SD: Standard deviation; IQR: Inter-quartile range.