Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Feb 4, 2017; 6(1): 79-84
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.79
Attributable cost of a nosocomial infection in the intensive care unit: A prospective cohort study
Binila Chacko, Kurien Thomas, Thambu David, Hema Paul, Lakshmanan Jeyaseelan, John Victor Peter
Binila Chacko, John Victor Peter, Medical ICU, Division of Critical Care, Christian Medical College, Vellore 632004, Tamil Nadu, India
Kurien Thomas, Department of Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India
Thambu David, Department of Medicine II, Christian Medical College, Vellore 632004, Tamil Nadu, India
Hema Paul, Hospital Infection Control Committee, Christian Medical College, Vellore 632004, Tamil Nadu, India
Lakshmanan Jeyaseelan, Department of Biostatistics, Christian Medical College, Vellore 632004, Tamil Nadu, India
Author contributions: Chacko B, Thomas K, David T and Peter JV contributed to conception and design of the study; Chacko B and Paul H were involved with data acquisition; Peter JV and Jeyaseelan L analysed the data; Chacko B and Peter JV interpreted the data and drafted the article; all authors critical revision and final approval of the version of the article to be published.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at Christian Medical College, Vellore, India. IRB Min No. 10011.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no financial implications or conflict of interest to declare for any of the authors.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: John Victor Peter, MD, DNB, MAMS, FRACP, FJFICM, FCICM, FICCM, Professor and Head, Medical ICU, Division of Critical Care, Christian Medical College, Ida Scudder Road, Vellore 632004, Tamil Nadu, India.
Telephone: +91-416-2282693 Fax: +91-416-2282035
Received: August 19, 2016
Peer-review started: August 22, 2016
First decision: September 28, 2016
Revised: October 27, 2016
Accepted: November 21, 2016
Article in press: November 22, 2016
Published online: February 4, 2017

To study the impact of hospital-acquired infections (HAIs) on cost and outcome from intensive care units (ICU) in India.


Adult patients (> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed.


The mean (± SD) age of the cohort (n = 499) was 42.3 ± 16.5 years. Acute physiology and chronic health evaluation-II score was 13.9 (95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76 (15.3%) patients developed an infection (ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median (inter-quartile range, IQR) INR 92893 (USD 1523) (IQR 57168-140286) vs INR 180469 (USD 2958) (IQR 140030-237525); P < 0.001 and longer duration of ICU (6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay (12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality (31.6% vs 27.2%; P = 0.49).


An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.

Keywords: Attributable cost, Nosocomial infection, Length of stay, Mortality, Intensive care

Core tip: There is paucity of data on the impact of hospital acquired infections (HAIs) on cost and outcome from intensive care units (ICU) in developing countries. In this prospective study of 499 patients admitted over 1-year to a medical ICU in India, there were 19.7 HAIs per 1000 ICU days. Occurrence of infection was associated with significantly higher treatment cost (P < 0.001); the median attributable cost of an infection was 87594 Rupees (USD 1436). Although ICU acquired infections increased ICU length of stay (6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01), it did not impact mortality (31.6% vs 27.2%; P = 0.49).