(293) Healthcare-Associated Infections in Patients With Hematologic Malignancies: A Nationwide Analysis

Monday, January 22, 2024

2:30 PM – 3:30 PM MT

Location: Connections Central - RST 13

First Author(s)

John A. Cuenca, MD (he/him/his)

Internal Medicine Resident
University of the Incarnate Word
San Antonio, Texas

Co-Author(s)

BM

Bernard Moscoso, PhD

Research fellow
b. ESPOL Polytechnic University, Escuela Superior Politécnica del Litoral, ESPOL, Centro de Investigaciones Economicas, Ecuador
DC

Diana Cardenas, MD

Infectious Diseases Fellow
Henry Ford Hospital, United States
MS

Marissa Schettino, MD

Research Coordinator
Houston Methodist Hospital, United States
DG

Daniel Gonzalez-Mosquera, MD

Internal Medicine Resident
Lincoln Medical Center, United States
PT

Pool Tobar, MD

Infectious Diseases Fellow
Mayo Clinic Arizona, United States
LG

Luis Gonzalez-Mosquera, MD

Hematology-Oncology Fellow
Henry Ford Hospital, United States
Joseph Nates, MD, MBA, FCCM, MCCM

Professor Department of Critical Care Medicine
University of Texas MD Anderson Center
Bellaire, Texas, United States

Introduction: Multiple infection control strategies have been implemented to reduce the burden of healthcare-associated infections (HAI). In the US, the estimated direct annual cost for managing HAIs ranges between $28-45 billion. Patients with hematological malignancies (HM) are immunosuppressed and are at higher risk of developing infections. Despite the clinical and epidemiological significance, there is lack of data of HAI among patients with HM. We conducted a study to describe the characteristics, demographics, clinical outcomes, and hospitalization costs in this population.

Methods: We analyzed the Nationwide Inpatient Sample database and identified patients with HM from 2016-2018. We used the ICD-10 codes and compared patients with and without HAI. The main outcomes were hospital resource utilization and in-hospital mortality. We computed the chi-squared test and the Mann-Whitney U-test to compare the characteristics, and outcomes. Analyses were conducted using Stata Statistical Software.

Results: During the study period, there were a total of 285,847 patients admitted with HM. Of them, 19,108 (6.7%) developed an HAI during their hospitalization. Patients with HAI were younger (66 vs 68) and had a higher proportion of patients with myeloid leukemia (24.8% vs 14.6%), and neutropenia (19.8% vs 9.4%). The most common HAIs were Clostridioides difficile infection (47.6%), followed by central-line associated blood-stream infections (18.1%), and catheter-associated urinary tract infections (8.5%). Patients with HAI required more invasive mechanical ventilation (8.9% vs 4.8%), and vasopressor support (2.4% vs 1.1%). Hospital stay was longer for patients with HAI (9 [5-20] vs 6 [4-10]). Hospital mortality rate was also higher (7.1% vs 4.3%). The total cost of hospitalization was $82,525 (40,518-208,754) for the patients with HAI compared to $54,035 (30,255-105,179) for the patients without HAI. All differences were statistically significant (P <.001).

Conclusions: Among patients with HM, those who developed HAI required more hospital resources and had worse clinical outcomes. Despite the advances made in infection control, there is still a significant burden placed on the healthcare system by nosocomial infections that should continue to be addressed.