Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres W.H. Sheng a , J.T. Wang b , D.C.T. Lu c , W.C. Chie d , Y.C. Chen a , S.C. Chang a, * a Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan, ROC b Department of Internal Medicine, Far-East Memorial Hospital, Taipei County, Taiwan, ROC c Department of Internal Medicine, Lo-Tung Poh-Ai Hospital, I-Lan County, Taiwan, ROC d Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei City, Taiwan, ROC Received 12 November 2003; accepted 27 May 2004 Available online 12 January 2005 KEYWORDS Hospital-acquired infection; Length of hospital stay; Medical cost; Mortality Summary To understand the impact of hospital-acquired infections on mortality and medical costs in modern medical care systems in different healthcare settings, we performed a case-control study at a medical centre and two community hospitals. A total of 144 and 129 adult case-control pairs who received care in a 2000-bed tertiary referral medical centre and two 800- bed community hospitals, respectively, between October 2002 and December 2002 were enrolled. Prolongation of hospital stay, extra costs and complications associated with hospital-acquired infections were analysed. Patients in the medical centre had more severe underlying disease status ðP , 0:001Þ; more malignancies ðP , 0:001Þ; more multiple episodes of hospital-acquired infection ðP ¼ 0:03Þ; and more infections with multidrug- resistant bacteria ðP , 0:001Þ than patients in community hospitals. The additional length of hospital stay and extra costs were similar for patients with hospital-acquired infections in the community hospitals and the medical centre (mean 19.2 days vs. 20.1 days, P ¼ 0:79; mean US$ 5335 vs. US$ 5058, P ¼ 0:83; respectively). The additional length of hospital stay and extra costs in both the medical centre and the community hospitals were not related to the sites of infection or the bacterial pathogens causing hospital-acquired infections, although medical costs attributable to hospital-acquired fungal infections due to Candida spp. were much higher for patients in the medical centre. Prevalence of hospital-acquired-infection-related complications, such as adult respiratory distress syndrome, disseminated intravascular coagulation, organ failure or shock, was similar between the two groups, but 0195-6701/$ - see front matter Q 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2004.06.003 Journal of Hospital Infection (2005) 59, 205–214 www.elsevierhealth.com/journals/jhin *Corresponding author. Address: Section of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, ROC. Tel.: þ 886-2-23123456x5401; fax: þ886-2-23971412. E-mail address: sc4030@ha.mc.ntu.edu.tw