泛耐药鲍曼不动杆菌呼吸机相关性肺炎的归因住院时长与住院费用研究

Study on attributable length of stay and hospitalization cost of ventilator-associated pneumonia caused by extensively drug resistant Acinetobacter baumannii

目的探讨重症监护病房(ICU)机械通气患者发生泛耐药鲍曼不动杆菌(XDRAB)呼吸机相关性肺炎的归因住院时长和住院费用,为医院ICU制定切实可行的感染防控策略及医疗资源的合理分配提供参考依据。方法回顾性收集2016年6月-2018年6月某三甲医院综合ICU收治的机械通气患者作为研究对象,采用倾向评分加权法平衡病例组和对照组的基线资料,采用秩和检验直接比较住院天数和住院费用的差异。结果均衡混杂因素后,结果显示病例组的ICU住院时间高于对照组,差异有统计学意义(P <0. 05),但2组的总住院时间差异无统计学意义(P> 0. 05)。病例组的总住院费用高于对照组(P <0. 05),且在药费、检查费、治疗费三方面均高于对照组(P <0. 05),但在护理费和耗材费方面差异无统计学意义(P> 0. 05)。结论 XDRAB呼吸机相关性肺炎会延长机械通气患者的ICU住院时间,增加住院经济负担,感染防控医疗资源支出可能存在分配不均的情况。

Objective To investigate the attributable length of stay and hospitalization cost of ventilator-associated pneumonia caused by extensively drug resistant Acinetobacter baumannii( XDRAB) in patients with mechanical ventilation in intensive care unit( ICU),and to provide a reference basis for developing a practical infection prevention and control strategy for hospital ICU and the rational allocation of medical resources. Methods Mechanical ventilation patients admitted to a comprehensive ICU in a tertiary hospital from June 2016 to June 2018 was collected retrospectively as the research object.The propensity score weighted method was used to balance the baseline data of the case group and the control group. The rank sum test was used to directly compare the difference in hospitalization days and hospitalization costs. Results After balancing the confounding factors,the results showed that the length of ICU stay in the case group was higher than that in the control group,and the difference was statistically significant( P < 0. 05),but the difference in total hospital stay between the two groups was not statistically significant( P > 0. 05). The total hospitalization cost of the case group was higher than that of the control group( P < 0. 05),and it was higher than that of the control group in terms of drug cost,examination cost and treatment cost( P < 0. 05),but there was no statistical significance in the differences of nursing cost and consumable cost( P > 0. 05). Conclusion XDRAB ventilator-associated pneumonia can prolong the ICU stay for patients with mechanical ventilation and increase the economic burden of hospitalization. and the expenditure on medical resources of infection prevention and control may be unevenly distributed.