PURPOSE: Patients on PAMV, though comprising 1/3 of all MV patients consume 2/3 of all the resources allocated to MV , and their numbers are projected to double by year 2020 . By virtue of their prolonged hospital length of stay (LOS, median 17 days ), they are subject to such nosocomial infections as CDAD, whose incidence and age-adjusted case fatality rate have doubled between 2000 and 2005 . We examined the rates and outcomes of CDAD among adult PAMV patients.
METHODS: We performed a cross-sectional analysis of 2005 data from the Health Care Utilization Project (HCUP)/Nationwide Inpatient Sample (NIS) from the Agency for Healthcare Research and Quality (AHRQ). PAMV and CDAD were identified using the ICD-9-CM codes 96.72 and 008.45, respectively.
RESULTS: Among 64,910 adult PAMV discharges in 2005, 3,468 (5.34%) had a concurrent diagnosis of CDAD. CDAD+ discharges were older (66.7+/−15.9 vs. 63.7+/−16.9 years, p<0.001), and more likely to be admitted from a long-term facility (9.9% vs. 5.2%, p<0.001) than CDAD-. While hospital mortality did not differ among PAMV discharges by CDAD status (32.6% CDAD+ and 33.0% CDAD-, p=0.598), the presence of CDAD was associated with significantly higher mean unadjusted hospital LOS (32.37+/−28.47 days CDAD+ and 22.18+/−19.53 days CDAD-, p<0.001), and charges ($211,322+/-$175,330 CDAD+ and $162,380+/-$145515 CDAD-, p<0.001).
CONCLUSION: PAMV patients have an order of magnitude higher risk of CDAD than other hospitalized patients . While not affecting mortality, concurrent CDAD infection is associated with increased hospital LOS and costs.
CLINICAL IMPLICATIONS: PAMV population is an attractive target for aggressive preventive CDAD measures.Zilberberg et al. Crit Care Med 2008:36;724–30Zilberberg et al. Crit Care Med 2008 Apr 21; [Epub ahead of print]Zilberberg et al. Emerg Infect Dis 2008, in press.
DISCLOSURE: Marya Zilberberg, None.