Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia
Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia
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DOI：
10.1001/archinternmed.2009.509
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发表时间：
2010-02-22
影响因子：
--
通讯作者：
Malani, Anup
中科院分区：
文献类型：
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作者：
Eber, Michael R.;Laxminarayan, Ramanan;Malani, Anup
背景：与医疗保健相关的感染每年影响170万住院患者，但这些感染造成的临床和经济成本却鲜为人知。需要对这些成本进行可靠的估计，以有效地将有限的资源用于最大的公共健康利益。方法：使用全国住院患者样本数据库中的医院出院记录，从1998至2006年间美国40个州的6900万医院出院病例中识别败血症和肺炎病例。使用改编自先前研究的标准排除社区获得性感染。由于这些标准可能不排除所有社区获得性感染，因此对与侵入性手术相关的病例的结果进行了单独检查，这些病例不太可能是先前存在的感染所致。使用多变量匹配分析和补充回归分析，根据出院记录估计可归因性住院时间、住院费用和住院粗死亡率。结果：在与侵入性手术相关的病例中，脓毒症的平均住院时间为10.9d，费用为32900美元，死亡率为19.5%；肺炎的相应数值分别为14.0d、46400美元和11.4%(P
Background: Health care-associated infections affect 1.7 million hospitalizations each year, but the clinical and economic costs attributable to these infections are poorly understood. Reliable estimates of these costs are needed to efficiently target limited resources for the greatest public health benefit.Methods: Hospital discharge records from the Nationwide Inpatient Sample database were used to identify sepsis and pneumonia cases among 69 million discharges from hospitals in 40 US states between 1998 and 2006. Community-acquired infections were excluded using criteria adapted from previous studies. Because these criteria may not exclude all community-acquired infections, outcomes were examined separately for cases associated with invasive procedures, which were unlikely to result from preexisting infections. Attributable hospital length of stay, hospital costs, and crude in-hospital mortality were estimated from discharge records using a multivariate matching analysis and a supplementary regression analysis. These models controlled for patient diagnoses, procedures, comorbidities, demographics, and length of stay before infection.Results: In cases associated with invasive surgery, attributable mean length of stay was 10.9 days, costs were $32900, and mortality was 19.5% for sepsis; corresponding values for pneumonia were 14.0 days, $46400, and 11.4%, respectively (P