Epidemiology and economic evaluation of severe sepsis in France:: age, severity, infection site, and place if acquisition (community, hospital, or intensive care unit) as determinants of workload and cost

Purpose: Severe sepsis is a leading cause of death in critically ill patients. We evaluated cost and workload according to infection site, place and time of acquisition, and severity. Material and Method: We used a prospective 3-year database from 6 intensive care units (ICUs) including 1698 patients. Results: Of the 1698 patients, 713 (42%) had severe sepsis at admission and 339 during the ICU stay (211 had both). Mortality was twice as high in patients with than those without ICU-acquired infection, independent of the presence of severe sepsis at admission. The mean (SD; median) cost of severe sepsis was 22 800 euro (21400 euro; 15 800 euro). Among patients with severe sepsis at admission, workload and cost were higher for pneumonia, peritonitis, and multiple-site infections and for hospital-acquired (17 400 euro [14 700 euro ; 17 400 euro ]) vs community-acquired infection (12 600 euro [12 100 euro ; 8900 euro ]). Intensive care unit-acquired severe sepsis was associated with greater than 3-fold increases in workload and costs. By multiple linear regression, older age, emergency surgery, septic shock, Acute Physiological and Chronic Health Evaluation II score, and hospital or ICU-acquired severe sepsis were independently associated with higher costs. Conclusions: The wide variations in cost and workload invite efforts to identify patient subgroups most likely to benefit from high-cost treatments and from prevention, particularly targeting severe nosocomial infections. (c) 2005 Elsevier Inc. All rights reserved.