In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital.
In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital.
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DOI：
10.1186/s12913-018-3549-0
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发表时间：
2018-09-26
影响因子：
2.8
通讯作者：
Kaier K
中科院分区：
文献类型：
--
作者：
Engler-Hüsch S;Heister T;Mutters NT;Wolff J;Kaier K
抗生素耐药性是传染病管理中的一项挑战，可能会造成巨大的成本。即使在没有感染的情况下，也必须采取措施，因为带有多药耐药(MDR)病原体的患者可能会传播病原体。我们的目标是使用来自一家德国教学医院的常规数据来量化社区获得的MDR殖民的成本。2011年至2014年记录的所有2006例入院时记录的MDR定植病例与7917例具有相同主要诊断的未暴露的对照相匹配。出现耐多药感染的病例被排除在分析之外。对三组耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)和耐多药革兰氏阴性菌(MDR-GN)的每个病例的常规成本数据进行了分析。进行了多变量分析以调整潜在的混杂因素。在控制了主要诊断组、年龄、性别和查尔森合并症指数后，从医疗保健角度来看，多药耐药定植与大量额外成本相关(1480.9欧元，95%CI为1286.4欧元-1675.5欧元)。病原体之间的异质性仍然存在。耐多药耐药性-GN的殖民导致的成本增长最大(1966.0欧元，95%CI欧元1634.6-2297.4欧元)，其次是耐甲氧西林金黄色葡萄球菌，欧元1651.3欧元(95%CI欧元1279.1欧元-2023.6欧元)，以及VRE欧元879.2欧元(95%CI欧元604.1欧元-1154.2欧元)。同时，多药耐药-GN还涉及887.8欧元的额外报销(95%CI为722.1-1053.6欧元)，即与多药耐药殖民相关的费用超过了报销。即使在没有侵袭性感染的情况下，入院时有记录的MDR殖民与医院成本的增加有关，而德国基于DRG的医院支付系统没有完全覆盖这一点。本文的在线版本(10.1186/s12913-0183549-0)包含补充材料，可供授权用户使用。
Antibiotic resistance is a challenge in the management of infectious diseases and can cause substantial cost. Even without the onset of infection, measures must be taken, as patients colonized with multi-drug resistant (MDR) pathogens may transmit the pathogen. We aim to quantify the cost of community-acquired MDR colonizations using routine data from a German teaching hospital. All 2006 cases of documented MDR colonization at hospital admission recorded from 2011 to 2014 are matched to 7917 unexposed controls with the same primary diagnosis. Cases with an onset MDR infection are excluded from the analysis. Routine data on costs per case is analysed for three groups of MDR bacteria: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and multidrug-resistant gram-negative bacteria (MDR-GN). Multivariate analyses are conducted to adjust for potential confounders. After controlling for main diagnosis group, age, sex, and Charlson Comorbidity Index, MDR colonization is associated with substantial additional costs from the healthcare perspective (€1480.9, 95%CI €1286.4–€1675.5). Heterogeneity between pathogens remains. Colonization with MDR-GN leads to the largest cost increase (€1966.0, 95%CI €1634.6–€2297.4), followed by MRSA with €1651.3 (95%CI €1279.1–€2023.6), and VRE with €879.2 (95%CI €604.1–€1154.2). At the same time, MDR-GN is associated with additional reimbursements of €887.8 (95%CI €722.1–€1053.6), i.e. costs associated with MDR-colonization exceed reimbursement. Even without the onset of invasive infection, documented MDR-colonization at hospital admission is associated with increased hospital costs, which are not fully covered within the German DRG-based hospital payment system. The online version of this article (10.1186/s12913-018-3549-0) contains supplementary material, which is available to authorized users.
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