Attributable Cost and Length of Stay Associated with Nosocomial Gram-Negative Bacterial Cultures.
Attributable Cost and Length of Stay Associated with Nosocomial Gram-Negative Bacterial Cultures.
复制标题
与院内革兰氏阴性细菌培养相关的可归因费用和住院时间。
DOI：
10.1128/aac.00462-18
复制
发表时间：
2018
影响因子：
4.9
通讯作者：
Samore,MatthewH
中科院分区：
文献类型：
--
作者：
Nelson,RichardE;Stevens,VanessaW;Jones,Makoto;Khader,Karim;Schweizer,MarinL;Perencevich,EliN;Rubin,MichaelA;Samore,MatthewH
很少有研究估计医院内培养的革兰氏阴性菌(GNB)导致的额外住院费用，而那些确实如此的研究往往受到时间依赖偏差的影响。我们的目标是通过使用美国退伍军人事务部独特的住院成本数据集来估计与医院培养相关的潜在感染的可归因性成本，该数据集使我们能够减少依赖时间的偏见。我们的研究包括2007年10月1日至2010年11月30日期间住院患者的数据。医院内GNB阳性培养定义为入院至出院后48小时内临床培养阳性不动杆菌、假单胞菌或肠杆菌科细菌。阳性培养进一步按耐药部位和水平进行分类。我们使用传统方法和旨在减少时间依赖偏差的影响的方法进行了分析。在这两种情况下，我们使用多变量广义线性模型来比较接受和不接受GNB医院培养的患者的住院费用和住院时间。在纳入常规分析的404,652名患者中，有12,356名患者进行了医院内GNB阳性培养。无论特定病原体、部位或耐药性水平如何，医院内GNB阳性培养的额外成本都是显著的。使用传统分析方法产生的估计比使用减少时间依赖偏差的方法产生的估计高出32.0%到131.2%。这些结果很重要，因为它们强调了可归因于这些感染的巨大财政负担，并提供了可用于评估改进感染控制的影响的基线。
Few studies have estimated the excess inpatient costs due to nosocomial cultures of Gram-negative bacteria (GNB), and those that do are often subject to time-dependent bias. Our objective was to generate estimates of the attributable costs of the underlying infections associated with nosocomial cultures by using a unique inpatient cost data set from the U.S. Department of Veterans Affairs that allowed us to reduce time-dependent bias. Our study included data from inpatient admissions between 1 October 2007 and 30 November 2010. Nosocomial GNB-positive cultures were defined as clinical cultures positive for Acinetobacter, Pseudomonas, or Enterobacteriaceae between 48 h after admission and discharge. Positive cultures were further classified by site and level of resistance. We conducted analyses using both a conventional approach and an approach aimed at reducing the impact of time-dependent bias. In both instances, we used multivariable generalized linear models to compare the inpatient costs and length of stay for patients with and without a nosocomial GNB culture. Of the 404,652 patients included in the conventional analysis, 12,356 had a nosocomial GNB-positive culture. The excess costs of nosocomial GNB-positive cultures were significant, regardless of specific pathogen, site, or resistance level. Estimates generated using the conventional analysis approach were 32.0% to 131.2% greater than those generated using the approach to reduce time-dependent bias. These results are important because they underscore the large financial burden attributable to these infections and provide a baseline that can be used to assess the impact of improvements in infection control.