摘要
目的:极低体重儿(VLBW)的院内血源性感染(NBISs)常导致病情加重及住院时间延长(LOS)。事实上,此前还没有根据不同的出生体重(BW)分组研究感染引起的治疗成本和住院时间增加的报道。本研究的目的是测算不同体重的VLBW由NBISs所导致的LOS及边缘成本增加。方法:笔者对来自于2000年新生儿重症监护质量促进合作组及佛蒙特洲牛津合作组的临床资料进行了回顾性研究。使用一元分析及多元回归方法来调查NBISs对医院成本及住院时间的影响。2000年新生儿重症监护质量促进合作组的17个新生儿重症监护单位将1998年1月1日至1999年12月31日出生的VLBW的临床及治疗费用资料都提交给了本研究。这些研究包括从大学到社区医院。结果:在2809例患儿中, 19.7%发生NBISs。对出生时体重在751 g到1500 g的患儿,NBISs导致治疗费用的显著增加。通过多元回归分析,对于出生时体重为401-750 g的VLBW,NBISs 的边缘成本为5875美元。而出生时体重为751- 1000g的患儿则为12480美元。所有的出生体重组住院时间都显著延长。通过多元回归分析,出生时体重为1001-1251 g的VLBW的住院时间增加了4d,而体重为751-1000 g的患儿则增加了7 d。结论:NBISs会导致治疗费用增加和住院期延长,其影响大小取决于患儿出生时体重。
Objective. Nosocomial bloodstream infections (NBIs) are associated with serious morbidity and prolonged length of stay (LOS) in very low birth weight (VLBW) infants. However, the marginal costs and excess LOS associated with these infections have never been measured in different birth weight (BW) categories after adjustment for many of the potentially confounding demographic variables, comor-bidities, and treatments. The objective of this studywas tomeasure the marginal cost and excess LOS caused by NBIs in surviving VLBW infants in different BW categories. Methods. This retrospective study examined data previously collected as part of the Neonatal Intensive Care Quality Improvement Collaborative 2000 and the Vermont Oxford Network clinical outcomes database. Univariate analyses and multiple regression were used to examine the effect of NBIs on hospital costs and LOS. Seventeen neonatal intensive care units that participated in the Neonatal Intensive Care Quality Improvement Collaborative 2000 submitted both clinical and financial data on their VLBW infants who were born from January 1, 1998, to December 31, 1999. This study included data from both university and community hospitals. Results. NBIs occurred in 19. 7% of 2809 patients included in this study. NBI was associated with significantly increased treatment costs for infants with BW751 to 1500 g. The marginal costs of NBIs, as estimated by multiple regression, varied from $5875 for VLBW infants with a BW of 401 to 750 g to $12 480 for those with BW of 751 to 1000 g. LOS was significantly increased in all BW categories. The excess LOS estimated by multiple regression varied from 4 days in VLBW infants with a BW of 1001 to 1251 g to 7 days in those with a BW of 751 to 1000 g. Conclusions. NBIs are associated with increased hospital treatment costs and LOS but by varying amounts depending on the BW. Preventing a single NBI could reduce the treatment costs of a VLBW infant by at least several thousand dollars. These savings are a greater percentage of the total treatment costs in VLBW infants with BW1001 to 1500 g than in smaller infants.
