综合ICU住院患者多重耐药菌医院感染与经济负担
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摘要
目的了解重症监护病房(ICU)多重耐药菌(MDRO)医院感染情况及其造成的经济负担。方法回顾性调查2016—2017年某院综合ICU住院患者中发生MDRO医院感染的病例,分析MDRO医院感染率、感染部位与耐药菌种类,采用配对病例对照研究比较MDRO医院感染与非感染患者住院日数、住院费用的差异。结果2016—2017年综合ICU住院患者MDRO医院感染率为7.5%,2017年低于2016年(4.5%vs 10.7%)。MDRO医院感染主要为下呼吸道感染(非呼吸机相关肺炎)、呼吸机相关肺炎以及手术部位感染,分别占50.0%、16.9%及10.8%。主要MDRO是耐碳青霉烯类鲍曼不动杆菌(CRAB)、耐甲氧西林金黄色葡萄球菌(MRSA)和耐碳青霉烯类铜绿假单胞菌(CRPA),分别占42.9%、24.8%和24.0%。MDRO感染者较非感染者住院日数延长26.0d,住院总费用增加116 147.0元(均P<0.001)。CRPA感染患者的住院日数最长、住院费用最高。结论综合ICU住院患者MDRO医院感染可增加住院日数和住院费用,给患者带来巨大的经济负担,应积极采取有效的MDRO感染防控措施,规范抗菌药物合理使用。
Objective To investigate the occurrence of healthcare-associated infection(HAI)caused by multidrugresistant organisms(MDROs)and economic burden due to MDRO HAI in an intensive care unit(ICU).Methods MDRO HAI occurred in patients in the general ICU of a hospital from2016 to 2017 was investigated retrospectively,infection rate,infection site,and drug-resistant bacteria were analyzed,difference in length of hospital stay and hospitalization expenses between patients with MDRO HAI and patients without infection were compared by matched case-control study.Results MDRO HAI rate in patients in general ICU in2016-2017 was 7.5%,MDRO HAI rate in 2017 was lower than that in 2016(4.5% vs 10.7%).The main MDRO HAI was lower respiratory tract infection(non-ventilator-associated pneumonia),ventilator-associated pneumonia,and surgical site infection,accounting for 50.0%,16.9%,and 10.8% respectively.The main MDROs were carbapenem-resistant Acinetobacter baumannii(CRAB),methicillin-resistant Staphylococcus aureus(MRSA)and carbapenem-resistant Pseudomonas aeruginosa(CRPA),accounting for 42.9%,24.8%,and24.0%respectively.The length of hospital stay of patients with MDRO infection were 26.0 days longer than patients without infection,and total hospitalization expenses increased by 116 147.0 yuan(all P<0.001).Patients with CRPA infection had the longest length of hospital stay and the highest hospitalization expenses.Conclusion MDRO HAI in general ICU patients can increase length of hospital stay and hospitalization expenses,and bring huge economic burden to patients,effective measures for prevention and control of MDRO infection should be taken to standardize the rational use of antimicrobial agents.
Objective To investigate the occurrence of healthcare-associated infection(HAI)caused by multidrugresistant organisms(MDROs)and economic burden due to MDRO HAI in an intensive care unit(ICU).Methods MDRO HAI occurred in patients in the general ICU of a hospital from2016 to 2017 was investigated retrospectively,infection rate,infection site,and drug-resistant bacteria were analyzed,difference in length of hospital stay and hospitalization expenses between patients with MDRO HAI and patients without infection were compared by matched case-control study.Results MDRO HAI rate in patients in general ICU in2016-2017 was 7.5%,MDRO HAI rate in 2017 was lower than that in 2016(4.5% vs 10.7%).The main MDRO HAI was lower respiratory tract infection(non-ventilator-associated pneumonia),ventilator-associated pneumonia,and surgical site infection,accounting for 50.0%,16.9%,and 10.8% respectively.The main MDROs were carbapenem-resistant Acinetobacter baumannii(CRAB),methicillin-resistant Staphylococcus aureus(MRSA)and carbapenem-resistant Pseudomonas aeruginosa(CRPA),accounting for 42.9%,24.8%,and24.0%respectively.The length of hospital stay of patients with MDRO infection were 26.0 days longer than patients without infection,and total hospitalization expenses increased by 116 147.0 yuan(all P<0.001).Patients with CRPA infection had the longest length of hospital stay and the highest hospitalization expenses.Conclusion MDRO HAI in general ICU patients can increase length of hospital stay and hospitalization expenses,and bring huge economic burden to patients,effective measures for prevention and control of MDRO infection should be taken to standardize the rational use of antimicrobial agents.
引文
[1]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[2]徐必生,袁华兵,杨萍.某三级综合医院多重耐药菌相关感染经济负担评估[J].中华实验和临床感染病杂志(电子版),2017,11(5):455-459.
[3]李辉,孙晓辉,欧柳红.综合ICU多重耐药菌感染的监测及综合干预研究[J].中国感染控制杂志,2013,12(3):196-198.
[4]Strich JR,Palmore TN.Preventing transmission of multidrugresistant pathogens in the intensive care unit[J].Infect Dis Clin North Am,2017,31(3):535-550.
[5]凌玲,吴伟旋,孙树梅,等.多重耐药菌医院感染直接经济负担的系统评价[J].中国感染控制杂志,2017,16(7):616-621.
[6]国家卫生和计划生育委员会.医院感染管理质量控制指标(2015年版)国卫办医函〔2015〕252号[Z].北京,2015.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[8]中华人民共和国卫生部.卫生部办公厅关于印发《多重耐药菌医院感染预防与控制技术指南(试行)》的通知[J].中华人民共和国卫生部公报,2011,13(2):59-61.
[9]中华人民共和国国家统计局.居民消费价格指数[EB/OL].[2018-11-08].http://data.stats.gov.cn/easyquery.htm?cn=C01.
[10]邢敏,邱会芬,王琳,等.连续3年多重耐药菌医院感染监测与经济负担评价[J].中国消毒学杂志,2017,32(11):1045-1047.
[11]袁晓宁.多重耐药菌的形成机理及其防控措施研究进展[J].中国消毒学杂志,2016,33(8):792-796.
[12]邓乃梅,王虹,王锦,等.ICU医院感染前瞻性监测与集束干预效果观察[J].中国消毒学杂志,2015,32(10):994-996.
[13]张丽红,陈贤君.重症监护病房多重耐药菌感染及耐药性变化趋势[J].中国消毒学杂志,2015,32(12):1209-1212.
[14]姜雪锦,孙吉花,邢敏,等.综合医院感染多药耐药菌特点及直接经济损失分析[J].中华医院感染学杂志,2016,26(24):5727-5729.
[15]Kurutkan MN,Kara O,Eraslan IH.An implementation on the social cost of hospital acquired infections[J].Int J Clin Exp Med,2015,8(3):4433-4445.
[16]Morales E,Cots F,Sala M,et al.Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition[J].BMC Health Serv Res,2012,12:122.
[17]Jarvis WR.医院感染[M].胡必杰,陈文森,高晓东,等,译.上海:上海科学技术出版社,2016.
[2]徐必生,袁华兵,杨萍.某三级综合医院多重耐药菌相关感染经济负担评估[J].中华实验和临床感染病杂志(电子版),2017,11(5):455-459.
[3]李辉,孙晓辉,欧柳红.综合ICU多重耐药菌感染的监测及综合干预研究[J].中国感染控制杂志,2013,12(3):196-198.
[4]Strich JR,Palmore TN.Preventing transmission of multidrugresistant pathogens in the intensive care unit[J].Infect Dis Clin North Am,2017,31(3):535-550.
[5]凌玲,吴伟旋,孙树梅,等.多重耐药菌医院感染直接经济负担的系统评价[J].中国感染控制杂志,2017,16(7):616-621.
[6]国家卫生和计划生育委员会.医院感染管理质量控制指标(2015年版)国卫办医函〔2015〕252号[Z].北京,2015.
[7]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[8]中华人民共和国卫生部.卫生部办公厅关于印发《多重耐药菌医院感染预防与控制技术指南(试行)》的通知[J].中华人民共和国卫生部公报,2011,13(2):59-61.
[9]中华人民共和国国家统计局.居民消费价格指数[EB/OL].[2018-11-08].http://data.stats.gov.cn/easyquery.htm?cn=C01.
[10]邢敏,邱会芬,王琳,等.连续3年多重耐药菌医院感染监测与经济负担评价[J].中国消毒学杂志,2017,32(11):1045-1047.
[11]袁晓宁.多重耐药菌的形成机理及其防控措施研究进展[J].中国消毒学杂志,2016,33(8):792-796.
[12]邓乃梅,王虹,王锦,等.ICU医院感染前瞻性监测与集束干预效果观察[J].中国消毒学杂志,2015,32(10):994-996.
[13]张丽红,陈贤君.重症监护病房多重耐药菌感染及耐药性变化趋势[J].中国消毒学杂志,2015,32(12):1209-1212.
[14]姜雪锦,孙吉花,邢敏,等.综合医院感染多药耐药菌特点及直接经济损失分析[J].中华医院感染学杂志,2016,26(24):5727-5729.
[15]Kurutkan MN,Kara O,Eraslan IH.An implementation on the social cost of hospital acquired infections[J].Int J Clin Exp Med,2015,8(3):4433-4445.
[16]Morales E,Cots F,Sala M,et al.Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition[J].BMC Health Serv Res,2012,12:122.
[17]Jarvis WR.医院感染[M].胡必杰,陈文森,高晓东,等,译.上海:上海科学技术出版社,2016.