某三甲医院细菌耐药健康及经济负担研究——以产超广谱β-内酰胺酶大肠埃希菌为例

Study on the health and economic burden of bacterial drug resistance in a tertiary care hospital--Escherichia coli producing extended-spectrumβ-lactamase as an example

目的 细菌耐药是全世界共同面对的公共健康难题,产生了严重的健康及经济威胁。本研究从医院视角进一步明确产超广谱β-内酰胺酶(ESBLs)大肠埃希菌感染导致的健康及经济负担,以期为细菌耐药相关政策干预的评估与优化提供实证依据。方法 选取江西省某三甲医院出院时间在2018—2019年的170,819住院人次样本为研究对象,并设置了ESBLs阳性感染组、ESBLs阴性感染组和无感染及定植组。采用倾向得分匹配(propensity score matching, PSM)对3个组进行1:1:100匹配,并采用Cox比例风险回归模型、多状态模型分别测算ESBLs阳性感染组相对于两对照组的死亡风险比(hazard ratio, HR)和额外床日数,最终基于医院视角测算额外住院成本。结果 经匹配后纳入分析的ESBLs阳性感染组、ESBLs阴性感染组和无感染及定植组的样本分别为885、885和81,245住院人次。ESBLs阳性感染组的死亡风险是无感染及定植组的2.58倍(P<0.001),同ESBLs阴性感染者相比并未显著增大患者的死亡风险(P=0.25)。ESBLs阳性感染组相较于其无感染及定植组和ESBLs阴性感染组产生的额外床日数分别为每例3.69 d和1.92 d,对应的额外住院成本为每例6,570.12元和3,418.60元。结论 产ESBLs大肠埃希菌感染会增加患者死亡风险,延长住院时间并加重患者的经济负担,应采取措施进行防控。

Objective Bacterial resistance is a pervasive and pressing public health issue worldwide that poses a significant threat to both healthcare and economies.This study aimed to provide a comprehensive analysis of the health and economic burden caused by Escherichia coli infections that produced extended-spectrumβ-lactamases(ESBLs)from the hospital perspective in order to provide empirical evidence for the evaluation and optimization of policy interventions related to antibiotic resistance.Methods The study selected a sample from 170,819 admissions discharged from a tertiary hospital in Jiangxi Province during 2018-2019.The sample was divided into three groups:the ESBLs-positive infection group,the ESBLs-negative infection group,and the non-infection and colonized group.Propensity score matching(PSM)was employed to match the three groups at a 1:1:100 ratio.Cox's proportional hazards regression model and multi-state model were used to measure the hazard ratio(HR)of death and the number of extra bed days in the ESBLs-positive infected group relative to the two control groups,respectively.Finally,the cost of extra hospitalization based on the hospital perspective was calculated.Results A matched sample of 885,885,and 81,245 admissions was included in the analysis for the ESBLs-positive,ESBLs-negative,and non-infected and colonized groups,respectively.The study found that the HR of death in the ESBLs-positive group was 2.58 times greater than in the non-infected group(P<0.001)and did not significantly increase the HR of death compared to those with ESBLs-negative infection(P=0.25).Furthermore,the ESBLs-positive group generated 3.69 and 1.92 additional bed days per case compared to its non-infected and ESBLs-negative counterparts,respectively.This corresponded to additional hospital costs of¥6,570.12 and¥3,418.60 per case.Conclusion ESBLs-producing Escherichia coli infections significantly increased the risk of death,prolonged hospitalization,and imposed substantial financial burdens on patients.Measures should be taken to prevent and control ESBLs infections.