某三级医院ICU多重耐药菌医院感染经济负担研究

Economic burden of healthcare-associated infection due to multidrug-resistant organisms in intensive care unit of a tertiary hospital

摘要:

目的 探讨重症监护病房(ICU)住院患者多重耐药菌(MDROs)医院感染的归因住院费用与住院时间。方法 选取某三级医院2017年10月—2018年12月入住ICU的1 378例患者为研究对象,其中发生MDROs医院感染者167例(MDROs组),其余患者1 211例(非MDROs组)。采用倾向指数匹配法(PSM)对MDROs组和非MDROs组进行1∶1匹配,对匹配后患者的住院费用和住院时间进行统计分析。结果 经PSM成功匹配166对,成功匹配率99.40%,匹配后MDROs组和非MDROs组住院时间中位数分别为34、16 d,中位数差值为18 d,两组比较差异有统计学意义(P<0.001);住院总费用分别为220 205.83、93 380.81元,差值为126 825.02元,两组比较差异有统计学意义(P<0.001)。除影像诊断费用外,MDROs组医疗服务费用、治疗操作费用、护理费用、实验诊断费用、临床诊断费用、西药费用和抗菌药物费用均高于非MDROs组(均P<0.05),其中两组间西药费用差值最大,为63 828.46元。结论 ICU患者发生MDROs医院感染会增加患者住院时间,加重患者经济负担,应采取措施进行防控。

Abstract:

Objective To explore hospitalization expense and length of hospital stay in patients with healthcare-associated infection(HAI) due to multidrug-resistant organisms(MDROs) in the intensive care unit(ICU). Methods 1 378 patients who were admitted to ICU in a tertiary hospital from October 2017 to December 2018 were recruited as the study objects, 167 of whom had MDROs infection (MDROs group), 1 211 patients without MDROs infection were in non-MDROs group. MDROs group and non-MDROs group were matched in a 1:1 ratio by propensity score matching(PSM), hospitalization expense and length of hospital stay of matched patients were analyzed statistically. Results A total of 166 pairs were successfully matched by using PSM, the successful matching rate was 99.40%, the median length of hospital stay in MDROs group and non-MDROs group were 34 and 16 days respectively, median difference was 18 days, difference between two groups was statistically significant (P<0.001); the total hospitalization expense was 220 205.83 and 93 380.81 Yuan respectively, difference was 126 825.02 Yuan, difference between two groups was statistically significant (P<0.001). Except the expense of image diagnosis, expense of medical service, treatment manipulation, nursing, experimental diagnosis, clinical diagnosis, western medicine and antimicrobial agents in MDROs group were all higher than non-MDROs group (all P<0.05), difference in expense of western medicine between two groups was the largest (63 828.46 Yuan). Conclusion MDROs healthcare-associated infection(HAI) in ICU patients will increase the length of hospital stay and economic burden of patients, preventive and control measures should be taken.