医院感染耐碳青霉烯类肠杆菌科细菌的直接经济负担分析

Direct economic burden of healthcare-associated infection with carbapenem-resistant Enterobacteriaceae

目的研究耐碳青霉烯类肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)感染患者住院期间的直接经济负担。方法将简阳市人民医院2017年1月-2019年6月检出CRE的患者按感染与定植分为感染组和定植组,使用多重线性回归分析两组间的混杂因素,然后运用倾向评分匹配法对两组的混杂因素进行匹配,再对两组患者住院的直接经济负担进行比较。结果共纳入2013例患者,其中CRE医院感染患者507例,CRE定植患者1506例。多重线性回归分析结果显示,除CRE感染外,机械通气、静脉置管、输血或使用血制品、泌尿道插管、气管切开、性别、手术、入住过重症监护病房、主要诊断和医疗保险类型也对患者住院直接经济负担有影响(P<0.05)。经倾向评分匹配后这些混杂因素在感染组(n=249)与定植组(n=249)间分布均衡,差异均无统计学意义(P>0.05)。CRE感染患者的中位总住院费用是CRE定植患者的1.29倍,多出15589.23元(Z=-3.116,P=0.002)。各种费用中,两组间中位费用差值最大的是西药费和实验室诊断费,分别多出4850.21元(Z=-3.460,P=0.001)和2613.00元(Z=-3.529,P<0.001);西药费中抗菌药物费在两组间差异明显,CRE感染患者的中位抗菌药物费是CRE定植患者的1.54倍,差异有统计学意义(Z=-3.391,P=0.001)。结论影响患者住院直接经济负担的因素很多,分析时需要尽可能避免混杂因素的影响;CRE感染患者明显比定植患者的住院经济负担大,应采取积极有效的防控策略与措施,预防和控制CRE感染的发生。

Objective To study the direct economic burden of hospitalization in patients with carbapenemresistant Enterobacteriaceae(CRE)infection.Methods Patients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group,and multiple linear regression analysis was used to analyze the confounding factors,and then propensity score matching method was used to match the confounding factors of the two groups,finally the direct economic burden of hospitalization was compared between the two groups.Results A total of 2013 patients were enrolled,including 507 CRE-infected patients and 1506 CRE-colonized patients.Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation,intravenous catheterization,blood transfusion or use of blood products,urinary intubation,tracheotomy,gender,surgery,intensive care unit stay,main diagnosis,and the type of medical insurance,together with CRE infection(P<0.05).After propensity score matching,these confounding factors were well balanced between the infection group(n=249)and the colonization group(n=249),and the differences were not statistically significant(P>0.05).The median of total hospitalization cost of CRE-infected patients was 1.29 times(15589.23 yuan more than)that of CRE-colonized patients and the difference between the two groups was statistically significant(Z=–3.116,P=0.002).The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine(4850.21 yuan;Z=–3.460,P=0.001)and the cost of laboratory diagnosis(2613.00 yuan;Z=–3.529,P<0.001),respectively.The cost of antimicrobial drugs differed significantly between the two groups(Z=–3.391,P=0.001),and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.Conclusions There are many factors affecting the direct economic burden of inpatients,and it is necessary to avoid the influence of confounding factors as far as possible during analysis.The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients,so active measures should be adopted to prevent and control CRE infection.