Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections
Costs and Mortality Associated With Multidrug-Resistant Healthcare-Associated Acinetobacter Infections
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DOI：
10.1017/ice.2016.145
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发表时间：
2016-10-01
影响因子：
4.5
通讯作者：
Samore, Matthew H.
中科院分区：
文献类型：
--
作者：
Nelson, Richard E.;Schweizer, Marin L.;Samore, Matthew H.
背景我们的目的是使用已发表的研究数据估计美国多重耐药（MDR）不动杆菌医疗保健相关感染（HA-Is）的每次感染和累积死亡率和费用负担。我们确定了估计MDR不动杆菌HAI导致的额外费用、住院时间（LOS）或死亡率的研究。我们使用3种方法估算了每例HAI的成本：（1）总成本估算，（2）从付款人的角度将LOS估算值乘以每例住院日的成本（4，350美元），（3）从医院的角度将LOS估算值乘以每例住院日的成本（2，030美元）。我们使用一个调整因子来缩小我们对时间依赖性偏倚的估计，该调整因子来自于使用时间固定方法和多状态模型（减少70.4%）或使用感染时间匹配有和无HAI患者（减少47.4%）来估计可归因LOS的研究。最后，我们使用MDR不动杆菌HAI的发生率来生成与这些感染相关的累积发生率、成本和死亡率。我们估计每次感染的成本分别为129，917美元（方法1）、72，025美元（方法2）和33，510美元（方法3）。合并的相对死亡风险为4.51（95% CI，1.10-32.65），得出的死亡率为10.6%（95% CI，2.5%-29.4%）。发病率为0.141（95%CI，0.136-0.161）/1，000患者-日，我们估计美国的年累积发病率为12，524（95%CI，11，509 - 13，625）。这里提出的估计与了解预防MDR不动杆菌HAI可以挽救的支出和生命有关。
BACKGROUND. Our objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HA-Is) in the United States using data from published- studies.METHODS. We identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections.RESULTS. Our estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10-32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%-29.4%). With an incidence rate of 0.141 (95% CI, 0.136-0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509-13,625) in the United States.CONCLUSION. The estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs.