Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs

Infect Control Hosp Epidemiol. 2003 Apr;24(4):251-6. doi: 10.1086/502196.


Objective: To determine the impact of vancomycin-resistant enterococcal bacteremia on patient outcomes and costs by assessing mortality, excess length of stay, and charges attributable to it.

Design: A population-based, matched, historical cohort study.

Setting: A 1,025-bed, university-based teaching facility and referral hospital.

Patients: Two hundred seventy-seven vancomycin-resistant enterococcal bacteremia case-patients and 277 matched control-patients identified between 1993 and 2000.

Results: The crude mortality rate was 50.2% and 19.9% for case-patients and control-patients, respectively, yielding a mortality rate of 30.3% attributable to vancomycin-resistant enterococcal bacteremia. The excess length of hospital stay attributable to vancomycin-resistant enterococcal bacteremia was 17 days, of which 12 days were spent in intensive care units. On average, dollars 77,558 in extra charges was attributable to each vancomycin-resistant enterococcal bacteremia. To adjust for severity of illness, 159 pairs of case-patients and control-patients, who had the same severity of illness (All Patient Refined-Diagnosis Related Group complexity level), were further analyzed. When patients were stratified by severity of illness, the crude mortality rate was 50.3% among case-patients compared with 27.7% among control-patients, accounting for an attributable mortality rate of 22.6%. Attributable excess length of stay and charges were 17 days and dollars 81,208, respectively.

Conclusion: Vancomycin-resistant enterococcal bacteremia contributes significantly to excess mortality and economic loss, once severity of illness is considered. Efforts to prevent these infections will likely be cost-effective.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteremia / economics*
  • Bacteremia / mortality*
  • Bacteremia / transmission
  • Cross Infection
  • Female
  • Hospital Charges / statistics & numerical data*
  • Hospital Mortality
  • Hospitals, Teaching
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Vancomycin Resistance*