耐亚胺培南鲍曼不动杆菌感染对临床及医疗费用的影响

The impact of imipenem-resistant Acinetobacter baumannii infection on clinical outcomes and medical care costs

目的了解耐亚胺培南鲍曼不动杆菌的医院感染对临床及医疗费用的影响。方法回顾性病例对照研究2007年1月至2009年6月于首都医科大学附属北京朝阳医院住院治疗的感染耐亚胺培南鲍曼不动杆菌患者和感染亚胺培南敏感鲍曼不动杆菌患者，分别为耐药组和敏感组，各138例。按年龄、性别、基础疾病严重程度、感染部位、住院时间及人院至出现感染的时间间隔等匹配因素随机选取敏感组患者进行1：1配对。计量资料的组间比较采用t检验或秩和检验，计数资料的组间比较采用X2检验，多因素分析采用Logistic回归。结果耐药组院内总病死率为39．1％，明显高于敏感组的20．3％（X2＝11.728，P〈0．01）。138对耐药组和敏感组患者中，有72对存活，耐药组的总住院时间及住ICU时间分别为28．5d和14．5d，均明显长于敏感组的23．0d及0d（X2＝2．886、4．844，均P〈0．01）。耐药组平均每住院日的总费用为3652元，抗菌药物费用为555元，均明显高于敏感组的2092元及338元（Z＝3．792、4．209，均P〈0．01）。结论耐亚胺培南鲍曼不动杆菌感染可显著升高患者的住院病死率、延长住院时间及增加住院费用。

Objective To investigate the impact of antimicrobial resistance on clinical outcomes and medical care costs among patients with imipenem-resistant Acinetobacter baumannii （IRAB） nosocomial infection. Methods A retrospective matched case-control study was performed to compare the differences of clinical outcomes and medical care costs between patients with IRAB infection and patients with imipenem-susceptive Acinetobacter baumannii （ISAB） infection in a tertiary care university teaching hospital in China from January 2007 to June 2009. Cases were matched to controls with ratio of 1 ： 1 on the basis of age, sex, severity of underlying diseases, source of infection, duration of hospitalization period and length of hospital stay before onset of infection. The measurement data between groups were compared by t test and rank test. The numeration data between groups were compared by X2 test. Multiple analysis was performed by Logistic regression. Results The total mortality rate of IRAB infection patients was significantly higher than that of ISAB infection patients （39.1% vs20.3% X2=11.728, P〈0.01）. Among 138 pairs of patients in IRABgroup and ISAB group, there were 72 matched case control pairs survived, which were significantly different in length of total hospital stay （28.5 days vs 23.0 days; ）C2 =2. 886, P〈0.01） and intensive care unit （ICU）stay （14.5 days vs 0 day; X2=4. 844, P〈0.01）. For all the 138 case-control pairs, everyday total hospitalization cost and everyday antibiotic therapy cost in IRAB cases were both higher than ISAB controls （RMB 3652 yuan vs RMB 2092 yuan; Z=3. 792, P〈0.01 and RMB 555 yuan vs RMB 338 yuan, Z=4. 209, P〈0.01）. Conclusion IRAB infection can increase the mortality rate, lengthen hospital stay and elevate the medical costs notably.