脑卒中患者耐碳青霉烯类鲍氏不动杆菌肺部感染的影响因素与经济负担分析

Influencing factors and economic burden of pneumonia caused by carbapenem-resistant Acinetobacter baumannii in stroke patients

目的分析脑卒中患者耐碳青霉烯类鲍氏不动杆菌肺部感染的影响因素及经济负担。方法对2016年1月1日-2018年12月31日某三级甲等医院神经外科脑卒中手术患者医院感染情况进行目标性监测,并对耐碳青霉烯类鲍氏不动杆菌肺部感染和非感染组患者进行1∶1病例对照匹配,共匹配患者33对。分析患者人口学资料、疾病临床特征、医院感染情况、住院费用等资料,归纳脑卒中手术患者耐碳青霉烯类鲍氏不动杆菌肺部感染的影响因素,并比较两组患者的住院费用和住院天数。结果共纳入脑卒中手术患者816例,其中35例发生耐碳青霉烯类鲍氏不动杆菌肺部感染。美国麻醉医师协会(ASA)评分、气管切开、机械通气是导致耐碳青霉烯类鲍氏不动杆菌肺部感染的影响因素(P<0.05)。感染组患者住院费用为156723.72(110505.78,197645.56)元,非感染组为73279.31(44474.85,98153.65)元,肺部感染直接经济负担为84201.56(42592.15,125220.73)元;感染组患者住院时间中位数为22.00(15.50,27.50)天,非感染组患者为13.00(10.00,17.00)天,感染使患者住院时间延长8.00(2.00,16.50)天。结论ASA评分、气管切开、机械通气会增加脑卒中患者发生耐碳青霉烯类鲍氏不动杆菌肺部感染的风险;肺部感染增加患者医疗费用,延长患者住院时间,加重患者经济负担。

OBJECTVE To investigate the influencing factors and economic burden of pneumonia caused by carbapenem-resistant Acinetobacter baumannii(CRAB)in stroke patients.METHODS Targeted surveillance of nosocomial infections in stroke patients in the neurosurgery department of a tertiary hospital was carried out from January 1,2016to December 31,2018.A total of 33pairs were matched in 1∶1match case-control study between the CRAB pneumonia group and the non-infected group,and the demographic characteristics,clinical characteristics of the disease,healthcare-associated infection information,and hospitalization expenses were collected.Risk factors of pneumonia caused by carbapenem-resistant A.baumannii in stroke patients were analyzed,and hospitalization costs and hospital length of stay were compared between the CRAB pneumonia group and the non-infected group.RESULTS A total of 816stroke patients were enrolled,of which 35suffered CRAB pneumonia.ASA score,tracheotomy,and mechanical ventilation were risk factors for CRAB pneumonia(P<0.05).The median hospitalization costs of the CRAB pneumonia group and the non-infected group were 156723.72(110505.78,197645.56)yuan and 73279.31(44474.85,98153.65)yuan,respectively;the direct economic burden of CRAB pneumonia was 84201.56(42592.15,125220.73)yuan.The median hospital length of stay of the CRAB pneumonia group was 22.00(15.50,27.50)days,extended by 8.00(2.00,16.50)days due to CRAB pneumonia than that of the non-infected group 13.00(10.00,17.00)days.CONCLUSIONASA score,tracheotomy,and mechanical ventilation might increase the risk of CRAB pneumonia.Pneumonia increased the medical expenses of patients,prolonged the length of hospital stay,and brought economic burden to patients.