Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus:: Relationships with antibiotic use and cost drivers
Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus:: Relationships with antibiotic use and cost drivers
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DOI：
10.1345/aph.1k501
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发表时间：
2008-03-01
影响因子：
2.9
通讯作者：
Bosso, John A.
中科院分区：
文献类型：
--
作者：
Mauldin, Patrick D.;Salgado, Cassandra D.;Bosso, John A.
背景技术背景：由于耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）引起的医院感染的发生率增加与某些抗生素的使用有关，并导致发病率、死亡率和护理费用增加。描述万古霉素和利奈唑胺使用与这些医院感染发生率随时间推移的关系，并确定与万古霉素和利奈唑胺使用费用增加相关的因素。方法：使用中断时间序列的分段回归分析评估机构范围内抗生素使用与院内MRSA和VRE感染率之间的关联。患者的特点和程序，以及某些抗生素的使用，对MRSA或VRE医院感染的患者的费用和住院时间的影响也进行了评估，并对2种类型的感染的成本驱动因素进行了比较。结果：我们的分析包括206例MRSA（n = 187）或VRE（n = 19）医院感染的患者。虽然少量的VRE医院感染可能会限制我们结果的推广，但我们发现万古霉素或利奈唑胺的使用与感染率之间没有显著关系。虽然平均住院费用相似，但不同感染类型的成本驱动因素有所不同。结论：MRSA或VRE感染的发生率似乎与万古霉素或利奈唑胺的使用无关。一些受影响的患者的护理费用相当高，虽然平均总住院费用相似，但两种感染类型之间的成本驱动因素似乎不同。
BACKGROUND: Increased incidence of nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) has been associated with the use of certain antibiotics and has resulted in increased morbidity, mortality, and costs of care.OBJECTIVE: To describe relationships between vancomycin and linezolid use and incidence of these nosocomial infections over time and to determine factors associated with the increased costs of care (cost drivers) associated with affected patients.METHODS: The association between institution-wide antibiotic use and the rate of nosocomial MRSA and VRE infections was assessed using segmented regression analysis for interrupted time series. The effect that patient characteristics and procedures, as well as certain antibiotic use, had on costs and length of stay of patients with MRSA or VRE nosocomial infection was also assessed and cost drivers for the 2 types of infections were compared.RESULTS: Our analysis included 206 patients who developed MRSA (n = 187) or VRE (n = 19) nosocomial infection. Although small numbers of VRE nosocomial infection may limit generalizations from our results, we found no significant relationship between vancomycin or linezolid use and the rate of either infection. While mean hospital costs were similar, cost drivers varied somewhat between infection types.CONCLUSIONS: The incidence of MRSA or VRE infections does not appear to be related to the use of vancomycin or linezolid. Costs of care are quite high in some affected patients and, while mean total hospital costs are similar, cost drivers appear to differ between the 2 infection types.