• Christophe Adrie, Corinne Alberti, Carine Chaix-Couturier, Elie Azoulay, Arnaud De Lassence, Yves Cohen, Patrick Meshaka, Christine Cheval, Marie Thuong, Gilles Troché, Maïté Garrouste-Orgeas, and Jean-François Timsit.
• Medical-Surgical ICU, Delafontaine Hospital, Saint Denis, France.
• J Crit Care. 2005 Mar 1;20(1):46-58.

PurposeSevere 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 MethodWe used a prospective 3-year database from 6 intensive care units (ICUs) including 1698 patients.ResultsOf 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 (21 400 ; 15 800 ). 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 [14,700; 17,400]) vs community-acquired infection (12,600 [12,100 ; 8900 ]). 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.ConclusionsThe 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.

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