Are There Differences in Hospital Cost Between Patients With Nosocomial Methicillin-Resistant Staphylococcus aureus Bloodstream Infection and Those With Methicillin-Susceptible S-aureus Bloodstream Infection?
Are There Differences in Hospital Cost Between Patients With Nosocomial Methicillin-Resistant Staphylococcus aureus Bloodstream Infection and Those With Methicillin-Susceptible S-aureus Bloodstream Infection?
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DOI：
10.1086/596731
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发表时间：
2009-05-01
影响因子：
4.5
通讯作者：
Mermel, Leonard A.
中科院分区：
文献类型：
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作者：
Ben-David, Debby;Novikov, Ilya;Mermel, Leonard A.
目标。为了研究耐甲氧西林对医院内金黄色葡萄球菌血流感染(BSI)发病后住院死亡率、住院时间和住院费用的影响。设计：一项回顾性队列研究。集合。罗德岛一家三级保健医院。PATIENTS。182名因甲氧西林敏感和耐甲氧西林金黄色葡萄球菌(分别为MSSA和MRSA)结果而发生医院内BSI的连续患者队列。患有MRSA BSI的患者在BSI发病前住院和重症监护病房(ICU)的总时间明显较长，且平均每日费用较高。与患有MSSA BSI的ICU患者相比，MRSA BSI患者的中位住院总费用(42,137美元比113,852美元)、感染后住院成本(17,603美元比51,492美元)和感染后住院时间(10.5天比20.5天)更长。经多因素调整后，感染MRSA BSI的ICU患者的总住院费用、感染后住院费用和感染后住院时间均显著增加。然而，使用倾向评分方法，我们发现，在ICU患者中，与MSSA BSI相比，MRSA感染后的费用和感染后住院时间的差异并不显著。非ICU患者发生MRSA或MSSA BSI后，经多因素调整或根据倾向性评分，差异无统计学意义。结论：根据倾向性评分，我们发现甲氧西林耐药并不独立地增加金黄色葡萄球菌感染后的住院费用或住院时间。我们认为，在队列研究中评估甲氧西林耐药性的影响时，在可比的患者子集上使用倾向评分可能是比多变量调整更好的方法。
OBJECTIVE. To examine the impact of methicillin resistance on in-hospital mortality, length of stay, and hospital cost after the onset of nosocomial Staphylococcus aureus bloodstream infection (BSI).DESIGN. A retrospective cohort study.SETTING. A tertiary care hospital in Rhode Island.PATIENTS. A cohort of 182 consecutive patients who developed nosocomial BSI due to methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA, respectively)RESULTS. Patients with MRSA BSI had a significantly longer total length of hospital and intensive care unit (ICU) stay before the onset of BSI and a higher average daily cost. Compared with ICU patients with MSSA BSI, those with MRSA BSI had a higher median total hospital cost ($42,137 vs $113,852), higher hospital cost after infection ($17,603 vs $51,492), and greater length of stay after infection (10.5 vs 20.5 days). After multivariable adjustment, ICU patients with MRSA BSI had significantly increased total hospital cost, hospital cost after infection, and length of stay after infection. However, using a propensity score approach, we found that, among ICU patients, the difference in cost after infection and the difference in length of stay after infection for MRSA, compared with MSSA BSI, were not significant. The differences among non-ICU patients who developed MRSA or MSSA BSI were not significant after multivariable adjustment or by propensity score.CONCLUSIONS. On the basis of propensity score, we found that methicillin resistance did not independently increase hospital cost or length of stay after onset of S. aureus BSI. We believe that use of a propensity score on a comparable subset of patients may be a better method than multivariable adjustment for assessing the impact of methicillin resistance in cohort studies.