Costs and control strategies of healthcare-associated infections in an Italian university hospital

BACKGROUNDS: Healthcare-associated infections (HAIs) increase morbidity, mortality, and costs, necessitating effective prevention strategies. This study estimates the additional costs of HAIs in a university hospital in Rome, Italy Policlinico Tor Vergata (PTV), to inform policymakers, healthcare professionals, and researchers. METHODS: We conducted a retrospective cohort study, including all patients admitted or discharged in 2018. We applied propensity score matching (PSM) to balance study groups and then we analysed cost differences using the average treatment effect on the treated (ATT) approach. Costs were calculated using the Diagnosis Related Groups (DRGs) system. Outcome measures included the real reimbursement cost in euros and the relative cost increment using adjusted logarithmic transformation. RESULTS: 12,033 patients were included: 6,653(55%) female, 5,380 (45%) male, with a median age of 67. In total, 1,212 (10.1%) infected patients were compared to 10,821 (89.9%) non-infected patients. Predominant infections were urinary tract infections (UTI) (48.8%) and blood stream infections (BSI) (34.4%), while Staphylococcus spp. (37.5%) and Enterococcus spp. (36.4%) were the most common pathogens. The propensity score analysis showed a 59.7% (95% CI: 48.8% to 71.3%) cost increase for infected patients. They incurred an additional €4,988 (95% CI: €4,173 to €5,804) in costs. Subgroup analyses revealed cost variations across infection sites and pathogens, with Klebsiella P. having the greatest economic impact at €7,586 (95% CI: €5,301 to €9,871) and BSI also at €9,719 (95% CI: €8,137 to €11,307). CONCLUSIONS: This study highlights the significant additional cost burden of HAIs in the PTV. Interventions with an equal or lower cost per HAI averted can be considered cost-effective. Public health actions, including enhancing infection prevention, developing or revising policies, and strengthening surveillance systems, should be prioritised to address ongoing HAI challenges. KEY MESSAGES: • Our study reveals a significant 59.7% cost increase (€4,988in our hospital) for HAI patients, highlighting the need for cost-effective prevention strategies in healthcare settings. • Findings emphasise the importance of enhancing infection prevention measures, policy development, and strengthening surveillance systems to reduce HAI-associated costs.