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Healthcare associated infections in gynecologic oncology: clinical and economic impact
  1. Antonella Biscione1,
  2. Giacomo Corrado1,
  3. Lorena Quagliozzi1,
  4. Alex Federico1,
  5. Rita Franco1,
  6. Laura Franza2,
  7. Enrica Tamburrini2,
  8. Teresa Spanu3,
  9. Giovanni Scambia1,4 and
  10. Anna Fagotti1,4
  1. 1Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  2. 2Department of Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  3. 3Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  4. 4Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
  1. Correspondence to Dr Giacomo Corrado, Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma 00168, Italy; giac.cor73{at}gmail.com

Abstract

Objective The purpose of this study was to assess the rate and type of infections in gynecological cancer patients. We also performed an economic analysis to provide an overview of costs related to healthcare associated infections.

Methods We retrospectively collected data from culture samples at the site of infection from patients undergoing surgery or chemotherapy, admitted to the Gynecologic Oncology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, from January 2017 to December 2018. We performed univariate and multivariate analyses to calculate potential risk factors for prolonged length of hospitalization. The average cost per patient was calculated, including the cost of hospital stay, operating room, medications, and diagnostic and invasive procedures.

Results Among 5682 patients, 322 (5.6%) gynecological cancer patients with healthcare associated infections were identified. A total of 249 patients (77.3%) had undergone surgery in the previous 30 days and 73 (22.7%) patients were receiving chemotherapy. In the whole population, the most common healthcare associated infections were urinary infections (58%) and surgical wound infections (42.1%). In addition, 14.5% of patients had central venous catheter infections and 21.7% had blood stream infections. Median length of stay was 20 days (range 1–100). Among surgical patients, advanced age (odds ratio (OR) 1.233, 95% confidence interval (CI) 1.001 to 1.519, p=0.049), bowel resection (OR 2.659, 95% CI 1.493 to 4.735, p=0.001), surgical site infection (OR 10.447, 95% CI 1.143 to 95.5, p=0.038), and central venous catheter infection (OR 9.856, 95% CI 1.139 to 85.319, p=0.038) were independently associated with an increased risk of prolonged hospital stay (>20 days). The overall direct cost of healthcare associated infections was $6 273 852 per year.

Conclusions The infection rate in our population was 5.6%. The most common healthcare associated infections were urinary and surgical wound infections. Among surgical patients, advanced age, bowel resection, surgical site, and central venous catheter infection were associated with an increased length of hospitalization. Healthcare associated infections cause an increase in the length of stay after surgery and hospital costs.

  • Pelvic Infection
  • Preoperative Care
  • Genital Neoplasms, Female

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

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  • Contributors All of the authors fulfilled the conditions required for authorship and approved the submission. AB and GC provided substantial contribution to the design of the project and drafted the article. LF, LQ, AF, and RF collected the data, giving an important contribution to critical aspects of the research. ET and TS revised the paper for important intellectual content. GS and AF approved the final version to be published. AB is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.