PIN23 DETERMINANTS OF TOTAL HOSPITAL COSTS AMONG INPATIENTS WITH CANDIDEMIA


A166 Abstracts

parison purposes, the mortality rate of all inpatients with S. aureus
infections was 7.3%. Patients with S. aureus cSSSIs were older
(mean age 54 years vs. 46 years for the comparison group) and
were more likely to have congestive heart failure, diabetes with
chronic complications and bacteremia/septicemia. Relative to the
comparison group, patients with S. aureus cSSSIs had significantly
(P < 0.0001) longer mean length of stay (9.7 vs. 4.4 days) and
higher average costs per stay ($16,941 vs. $9,154). After con-
trolling for potentially confounding factors, the excess mean costs
associated with S. aureus cSSSIs were estimated to be $3,396.
CONCLUSION: Our findings suggest that the clinical and eco-
nomic burden of complicated skin and skin structure infections
(cSSSIs) due to Staphylococcus aureus among hospitalized
patients is substantial.

PIN22
IMPACT OF S. AUREUS INFECTIONS ON EXPENDITURES AND
LENGTH-OF-STAY IN U.S. HOSPITALS
Noskin G1, Rubin R2, Schentag J3, Kluytmans J4, Hedblom E5,
Jacobson C5, Smulders M6, Gemmen EK7, Bharmal M7
1Northwestern University Feinberg School of Medicine, Chicago, IL,
USA, 2Georgetown University, Washington, DC, USA, 3University at
Buffalo School of Pharmacy, Buffalo, NY, USA, 4Amphia Hospital and
VUmc Medical University, Amsterdam, 4800 RK, The Netherlands,
53M Medical, St Paul, MN, USA, 6Quintiles, Falls Church, VA, USA,
7Quintiles Strategic Research & Safety, Falls Church, VA, USA
OBJECTIVES: Evaluate the incremental impact of S. aureus
infection stays on hospital charges and length-of-stay in U.S.
hospitals in 2003. METHODS: The 2003 Nationwide Inpatient
Sample data were analyzed. Hospital discharges were classified
as either a S. aureus–related infection stay or a non-S. aureus-
related infection stay using a combination of several ICD-9
codes. Incremental effect of S. aureus infection on hospital
charges and length-of-stay was estimated using multivariate
regression models adjusting for hospital fixed effects and patient
variables including age, gender, race, payer, diagnosis-related
grouping and concomitant conditions including diabetes, dialy-
sis and lung disease. RESULTS: S. aureus infection was reported
as a discharge diagnosis for 1.0% of all hospital inpatients, or
389,963 stays, in 2003. S. aureus infection hospital stays were
significantly more likely among male, older patients, stays that
were paid by Medicare, white or non-Hispanics and hospital
stays among individuals with diabetes, lung disease or dialysis.
After adjusting for covariates, the mean incremental impact of
S. aureus infection on hospital charges and length-of-stay was
$37,251 (95% Confidence Interval (CI): $34,678–$39,823) and
8.2 days (95% CI: 7.9–8.5) among all inpatient stays, $40,637
(95% CI: $37,683–$43,591) and 9.2 days (95% CI: 8.8–9.6)
among surgical stays, $83,952 (95% CI: $75,853–$92,052) and
16.8 days (95% CI:15.7–17.9) among invasive cardiovascular
stays, $34,202 (95% CI: $29,612–$38,791) and 9.6 days (95%
CI: 9.0–10.2) among invasive orthopedic stays and $119,292
(95% CI: $106,209–$132,374) and 19.8 days (95% CI:
17.5–22.2) among invasive neurosurgical stays. CONCLUSION:
S. aureus infections present a considerable economic burden to
U.S hospitals. Based on the prevalence of S. aureus infection and
its incremental impact, the total economic impact of S. aureus
among all hospital admissions was estimated at $14.5 billion in
2004 U.S. dollars.

PIN23
DETERMINANTS OF TOTAL HOSPITAL COSTS AMONG
INPATIENTS WITH CANDIDEMIA
Lee SP1, Bunz T2, Gagne JJ2, Maio V2, Goldfarb NI2, Horn DL2,
Swanson R3
1Thomas Jefferson Univeristy, Philadelphia, PA, USA, 2Thomas Jefferson
University, Philadelphia, PA, USA, 3Pfizer Inc, New York, NY, USA
OBJECTIVES: To identify factors associated with total hospital
costs among patients with candidemia in a large, urban, tertiary
care, teaching hospital. METHODS: This retrospective cohort
study examined hospitalizations during calendar years 2004 and
2005 at Thomas Jefferson University Hospital in Philadelphia,
PA, using data from various hospital systems. Candidemia cases
were identified via the microbiological laboratory information
system as those patients with at least one confirmed positive
blood culture for any Candida species at any point during the
study period. Demographic, economic, and clinical data, includ-
ing length-of-stay (LOS), payer types, total costs, and Diagnosis
Related Group (DRG) assignments were collected from the hos-
pital cost accounting system. Pharmacy data (i.e. medications
administered and associated costs) were retrieved from the phar-
macy electronic information system. A multivariate regression
analysis, using the natural logarithm of total hospitalization
costs as the dependent variable, was conducted. Independent
variables included demographic information, relative DRG
weights, and Candida species. RESULTS: Among 68,526 total
hospitalizations during the study period, 287 cases were con-
firmed positive for candidemia. The mean age of cases was 58
years, 52% were female, and 60% were Caucasian. The mean
LOS was 43.3 days and the average inpatient cost for candidemia
cases was $130,759 (SD = $116,560; median, $97,869). The
most common Candida species was C. albicans (n = 127; 44%).
The most commonly used antifungal treatment was fluconazole
(N = 176, 61%). Age, and relative DRG weights (p < 0.05) were
significantly positively correlated with total hospital costs. Older
patients with higher relative DRG weights were associated with
the higher total costs. Race, gender, and marital status were not
associated with total costs. CONCLUSION: Relative DRG
weights, as well as age are associated with total hospital costs
among patients with candidemia. Candidemia is expensive to
treat and results in lengthy hospital stay. Early detection and
treatment may significantly reduce resource use as well as
improve outcomes.

PIN24
THE ECONOMIC IMPACT OF METHICILLIN RESISTANCE IN
STAPHYLOCOCCUS AUREUS BACTEREMIA IN KOREA
Park EJ1, Lee EK2, Chae S3
1Korea Institute for Health and Social Afffairs, Seoul, South Korea,
2Sookmyung Women’s University, Seoul, South Korea, 3Korea Institute
for Health and Social Affairs, Seoul, South Korea
OBJECTIVES: The objective of this study is to examine the eco-
nomic outcome of Methicillin resistance in Staphylococcus
aureus bacteremia in Korea, where MRSA is endemic in major-
ity of hospitals. METHODS: We conducted retrospective case-
control study of patients admitted to three university-based
teaching hospitals in Seoul, Korea in 2005. Cases were defined
as patients with Methicillin-resistant S. aureus (MRSA) bac-
teremia and controls were Methicillin- susceptible S. aureus
(MSSA) bacteremia selected according to a priori matching cri-
teria. 58 cases and 58 controls were identified. Hospital charges
were collected from hospitals’ billing system. RESULTS: The
median hospital charge after the development of bacteremia was
higher for cases with MRSA bacteremia ($8245) than for con-
trols with MSSA bacteremia ($6569). The median hospital