A multi-center nested case-control study on hospitalization costs and length of stay due to healthcare-associated infection

Abstract Objectives: The association between blood transfusion and ventilator-associated events (VAEs) has not been fully understood. We sought to determine whether blood transfusion increases the risk of a VAE. Design: Nested case-control study. Setting: This study was based on a registry of healthcare-associated infections in intensive care units at West China Hospital system. Patients: 1,657 VAE cases and 3,293 matched controls were identified. Methods: For each case, 2 controls were randomly selected using incidence density sampling. We defined blood transfusion as a time-dependent variable, and we used weighted Cox models to calculate hazard ratios (HRs) for all 3 tiers of VAEs. Results: Blood transfusion was associated with increased risk of ventilator-associated complication-plus (VAC-plus; HR, 1.47; 95% CI, 1.22–1.77; P <.001), VAC-only (HR, 1.29; 95% CI, 1.01–1.65; P = .038), infection-related VAC-plus (IVAC-plus; HR, 1.78; 95% CI, 1.33–2.39; P < .001), and possible ventilator-associated pneumonia (PVAP; HR, 2.10; 95% CI, 1.10–3.99; P = .024). Red blood cell (RBC) transfusion was also associated with increased risk of VAC-plus (HR, 1.34; 95% CI, 1.08–1.65; P = .007), IVAC-plus (HR, 1.70; 95% CI, 1.22–2.36; P = .002), and PVAP (HR, 2.49; 95% CI, 1.17–5.28; P = .018). Compared to patients without transfusion, the risk of VAE was significantly higher in patients with RBC transfusions of >3 units (HR, 1.73; 95% CI, 1.25–2.40; P = .001) but not in those with RBC transfusions of 0–3 units. Conclusion: Blood transfusions were associated with increased risk of all tiers of VAE. The risk was significantly higher among patients who were transfused with >3 units of RBCs.

Download Full-text

Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.11 ◽

2019 ◽

Vol 8 (5) ◽

pp. 300-306 ◽

Cited By ~ 10

Author(s):

Zhila Najafpour ◽

Zahra Godarzi ◽

Mohammad Arab ◽

Mehdi Yaseri

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Case Control Study ◽

Case Control ◽

Patient Falls ◽

Increased Risk ◽

Risk Factors For Falls ◽

Clinical Records ◽

Nested Case Control ◽

Control Study

Background: Patient falls are considered a challenge to the patient’s safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group. Methods: A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis. Results: In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI=0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR=6.93; CI=4.22 to 11.38), balance condition (OR= 6.41; CI=4.51 to 9.11), manual transfer aid (OR=8.47; CI=5.65 to 12.69), urinary incontinence (OR= 8.47, CI= 5.65 to 12.69), and cancer (OR=2.86, CI=1.84-4.44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR=0.48; CI= 1.003 to 1.02), poly-pharmacy (OR=1.37, CI=00.85 to 2.2), stroke (OR=0.94, CI= 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio=1.01, CI=0.01 to 0.03) were not significantly associated with falling in hospitals. Conclusion: It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions.

Download Full-text

Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

Antibiotics ◽

10.3390/antibiotics10030302 ◽

2021 ◽

Vol 10 (3) ◽

pp. 302

Author(s):

Giuseppe Migliara ◽

Valentina Baccolini ◽

Claudia Isonne ◽

Sara Cianfanelli ◽

Carolina Di Paolo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Nested Case Control ◽

Control Study

Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR Klebsiella pneumoniae (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents.

Download Full-text

Excess Length of Stay Attributable to Surgical Site Infection Following Hip Replacement: A Nested Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1086/509828 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1299-1303 ◽

Cited By ~ 43

Author(s):

Vicente Monge Jodra ◽

Lourdes Sainz de los Terreros Soler ◽

Cristina Díaz-Agero Pérez ◽

Carmen María Saa Requejo ◽

Nieves Plana Farrás

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Hospital Stay ◽

Hip Replacement ◽

Case Control Study ◽

Case Control ◽

Site Infection ◽

Nested Case Control ◽

The Impact ◽

Control Study

Objective. We estimated the impact of hip replacement-associated surgical site infection (SSI) on morbidity and length of stay. Methods. This was a pairwise matched (1 : 1) case-control study nested in a cohort. All patients who underwent hip replacement from January 1, 2000, to June 30, 2004, were prospectively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge, including any patients readmitted because of infection. Results. Among the 1,260 hip replacements performed, 28 SSIs were detected, yielding a crude SSI rate of 2.2%. The median excess length of stay attributable to SSI was 32.5 days (P< .001), whereas the median prolonged postoperative stay due to SSI was 31 days (P< .001). Deep-wound SSI was the type that prolonged hospital stay the most (up to 49 days). Of the patients who developed an SSI, 4 required revision surgery, for an SSI-related morbidity rate of 14.3%. Conclusion. SSI prolongs hospital stay; however, although hospital stay is a rough indicator of the cost of this complication, to accurately estimate the costs of SSI, we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors.

Download Full-text

Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case–control study

BMJ Open ◽

10.1136/bmjopen-2018-026771 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026771 ◽

Cited By ~ 6

Author(s):

Pei-Ju Liao ◽

Chien-Tai Mao ◽

Tun-Liang Chen ◽

Shin-Tarng Deng ◽

Kuang-Hung Hsu

Keyword(s):

Length Of Stay ◽

Poor Prognosis ◽

Case Control Study ◽

Case Control ◽

Psychoactive Drugs ◽

Medical Expenses ◽

Factors Associated ◽

Older Inpatients ◽

Nested Case Control ◽

Control Study

ObjectiveOlder patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients.DesignA nested case–control study.SettingA medical centre located in north Taiwan.Participants539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected.ExposurePolypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses.Primary and secondary outcome measuresADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes.ResultsThe admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively.ConclusionsThe number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care.

Download Full-text

Excess Length of Stay Attributable to Surgical Site Infection Following Hip Replacement: A Nested Case-Control Study

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700075214 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1299-1303 ◽

Cited By ~ 8

Author(s):

Vicente Monge Jodra ◽

Lourdes Sainz de los Terreros Soler ◽

Cristina Díaz-Agero Pérez ◽

Carmen María Saa Requejo ◽

Nieves Plana Farrás

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Hospital Stay ◽

Hip Replacement ◽

Case Control Study ◽

Case Control ◽

Site Infection ◽

Nested Case Control ◽

The Impact ◽

Control Study

Objective.We estimated the impact of hip replacement-associated surgical site infection (SSI) on morbidity and length of stay.Methods.This was a pairwise matched (1 : 1) case-control study nested in a cohort. All patients who underwent hip replacement from January 1, 2000, to June 30, 2004, were prospectively enrolled for the nested case-control design analysis and were monitored from the time of surgery until hospital discharge, including any patients readmitted because of infection.Results.Among the 1,260 hip replacements performed, 28 SSIs were detected, yielding a crude SSI rate of 2.2%. The median excess length of stay attributable to SSI was 32.5 days (P< .001), whereas the median prolonged postoperative stay due to SSI was 31 days (P< .001). Deep-wound SSI was the type that prolonged hospital stay the most (up to 49 days). Of the patients who developed an SSI, 4 required revision surgery, for an SSI-related morbidity rate of 14.3%.Conclusion.SSI prolongs hospital stay; however, although hospital stay is a rough indicator of the cost of this complication, to accurately estimate the costs of SSI, we would need to consider individual costs in a linear regression model adjusted for all possible confounding factors.

Download Full-text