The cost of hospitalizations for treatment of hemodialysis catheter-associated blood stream infections in children: a retrospective cohort study

Background Hospitalization costs for treatment of hemodialysis (HD) catheter-associated blood stream infections (CA-BSI) in adults are high. No studies have evaluated hospitalization costs for HD CA-BSI in children or identified factors associated with high-cost hospitalizations. Methods We analyzed 160 HD CA-BSIs from the Standardizing Care to Improve Outcomes in Pediatric End-stage Kidney Disease (SCOPE) collaborative database linked to hospitalization encounters in the Pediatric Health Information System (PHIS) database. Charge-to-cost ratios were used to convert hospitalization charges reported in PHIS database to estimated hospital costs. Generalized linear mixed modeling was used to assess the relationship between higher-cost hospitalization (cost above 50 th percentile) and patient and clinical characteristics. Generalized linear regression models were used to assess differences in mean service line costs between higher- and lower-cost hospitalizations. Results The median (IQR) length of stay for HD CA-BSI hospitalization was 5 (3–10) days. The median (IQR) cost for HD CA-BSI hospitalization was $18,375 ($11,584–$36,266). ICU stay (aOR 5.44, 95% CI 1.62–18.26, p = 0.01) and need for a catheter procedure (aOR = 6.08, 95% CI 2.45–15.07, p < 0.001) were associated with higher-cost hospitalization. Conclusions Hospitalizations for HD CA-BSIs in children are often multiple days and are associated with substantial costs. Interventions to reduce CA-BSI may reduce hospitalization costs for children who receive chronic HD. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information