Evaluation of economic burden induced by multidrug-resistant bacteria related infectons in a tertiary general hospital

doi:10.3877/cma.j.issn.1674-1358.2017.05.006

Abstract

Abstract:

Objective

To investigate the effect multidrug-resistant arganisms (MDROs) related infections on the total hospitalization expense, antibacterial drug costs and the average hospital stay, and to evaluate the economic burden induced multidrug-resistant bacteria and manage and control multiple drug-resistant bacteria in a tertiary general hospital.

Methods

In 2015, a retrospective survey was conducted to collecte the related data of the patients with MDROs and non-MDROs, and the average hospital stay, the total hospitalization expense, antibacterial drug costs were statistically analyzed, respectively.

Results

The detection rate of carbapenem-resistant Acinetobacter baumannii (CRAB) related infections was 54.08%, and the rates of ESBLs-producing proteus mirabilis, Escherichia coli and Klebsiella pneumoniae were respectively 38.76%, 33.31% and 26.01%, and the rate of multidrug-resistant Enterobacter cloacae was 36.15%. The average hospital stay of patients with multidrug-resistant bacteria were 64 days (Pseudomonas aeruginosa), 29 days (Enterobacter cloacae) and 26 days (coagulase negative Staphylococcus), significantly longer than 18 days of non-MDROs (t = 9.03, P < 0.001; t = 3.39, P = 0.001; t = 3.09, P = 0.002). The total hospitalization/antibacterial drug expense multidrug-resistant bacteria were 86 063/5 506 RMB (Pseudomonas aeruginosa), 48 500/2 402 RMB (Enterobacter cloacae) and 56 221/2 254 RMB (coagulase negative Staphylococcus), significantly more than 23 958/2 024 RMB, 23 741/1 590 RMB and 20 024/1 318 RMB (all P < 0.05).

Conclusions

The MDROs related infections could increase the average hospital stay and the economic burden. It urgent to take effective management and control for health care associated infections and to improve the reasonable application of antimicrobial drug in order to lessen the economic burden.

Key words: Multidrug-resistant bacteria, Extended spectrum beta-lactamases, Nosocomial infections

Bisheng Xu, Huabing Yuan, Ping Yang. Evaluation of economic burden induced by multidrug-resistant bacteria related infectons in a tertiary general hospital[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(05): 455-459.

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References 28

[1]	冯保英, 耿荣华. 呼吸科多重耐药菌感染的相关因素及预防措施[J/CD]. 中华实验和临床感染病杂志(电子版),2015,9(4):513-515.
[2]	刘建华, 袁华兵. 右胫腓骨开放性粉碎性骨折并发两种多重耐药菌感染一例[J/CD]. 中华实验和临床感染病杂志(电子版),2014,8(2):111-112.
[3]	王虹, 易美玲, 丁伟建, 等. 多学科合作管理多重耐药菌的效果[J]. 中国感染控制杂志,2015,12(14):846-848.
[4]	黄勋, 邓子德, 倪语星, 等. 多重耐药菌医院感染预防与控制中国专家共识[J]. 中国感染控制杂志,2015,14(1):1-9.
[5]	董衍军, 成凤韬. 重症脑卒中患者多药耐药菌感染的调查分析[J/CD]. 中华实验和临床感染病杂志(电子版),2014,8(4):552-555.
[6]	杨兴肖, 邢亚威, 马鸣, 等. 651株产超广谱β-内酰胺酶大肠埃希菌的耐药性变迁[J]. 现代预防医学,2015,42(3):519-521, 547.
[7]	邢敏, 邱会芬, 姜雪锦, 等. 某三级综合医院多药耐药菌医院感染经济损失分析[J]. 中华医院感染学杂志,2015,25(21):4879-4881.
[8]	Mutters NT, Gunther F, Frank U, et al. Costs and possible benefits of a two-tier infection control management strategy consisting of active screening for multidrug-resistant organisms and tailored control measures[J]. J Hosp Infect,2016,93(2):191-196.
[9]	Huebner C, Roggelin M, Flessa S. Economic burden of multidrug-resistant bacteria in nursing homes in Germany: a cost analysis based on empirical data[J]. BMJ Open,2016,6(2):e008458.
[10]	Gerlich MG, Piegsa J, Schäfer C, et al. Improving hospital hygiene to reduce the impact of multidrug-resistant organisms in health care----a prospective controlled multicenter study[J]. BMC Infect Dis,2015,15(22):441-453.
[11]	习慧明, 徐英春, 朱德妹, 等. 2010年中国CHINET鲍曼不动杆菌耐药性监测[J]. 中国感染与化疗杂志,2012,12(2):98-104.
[12]	罗必蓉, 刘蓉, 刘继芬, 等. 阴沟肠杆菌耐药性及氨基糖苷类抗生素耐药基因分析[J]. 成都医学院学报,2011,6(3):248-250
[13]	Zubair AQ, David LP, Diana LP. Risk factors and outcome of extended-spectrum β-lactamase-producing Enterobacter cloacae bloodstream infections[J]. Int J Antimicrob Agents,2011,37(1):26-32.
[14]	赵红霞, 轩凯. 临床分离多重耐药菌感染类型及变化趋势[J]. 中国感染控制杂志,2014,13(6):371-373.
[15]	Vrijens F, Hulstaert F, Van de Sande S, et al. Hospital-acquired, laboratory-confirmed bloodstream infections: linking national surveillance data to clinical and financial hospital data to estimate increased length of stay and healthcare costs[J]. J Hops Infect,2010,75(3):158-162.
[16]	孙吉花, 邢敏, 姜雪锦, 等. 多药耐药菌医疗相关感染经济损失评价[J]. 中华医院感染学杂志,2015,25(11):2587-2588, 2612.
[17]	王丽娟, 徐修礼, 史皆然, 等. 多药耐药铜绿假单胞菌研究进展[J]. 国际检验医学杂志,2013,34(13):1713-1715.
[18]	魏宏莲, 王崇, 苏军华, 等. 临床分离铜绿假单胞菌耐药性分析与监控管理[J]. 河北医科大学学报,2015,36(1):45-47.
[19]	彭敬红, 侯彦强, 郑蓉, 等. 铜绿假单胞菌耐药性分析[J]. 中华医院感染学杂志,2015,25(8):1696-1698.
[20]	杨玉杰, 于魁忠, 张丽君, 等. 铜绿假单胞菌耐药性分析及医院感染控制对策[J]. 中华医院感染学杂志,2013,23(15):3755-3756.
[21]	Park SY, Park HJ, Moon SM, et al. Impact of adequate empirical combination therapy on mortality from bacteremic Pseudomonas aeruginosapneumonia[J]. BMC Infect Dis,2012,12(14):308-315.
[22]	刘双. 114株阴沟肠杆菌的耐药性及分布[J/CD]. 中华实验和临床感染病杂志(电子版),2012,6(02):101-103.
[23]	George AJ. AmpC β-lactamases[J]. Clin Microbiol Rev,2009,22(1):161-182.
[24]	莫基浩, 李少侠, 任伟宏, 等. 产超广谱β-内酰胺酶及AmpC酶阴沟肠杆菌的检测与耐药性分析[J]. 中华医院感染学杂志,2015,25(9):1945-1947.
[25]	于莹璐, 王蓓, 田月如, 等. 医院感染阴沟肠杆菌的分布与耐药性分析[J]. 中华医院感染学杂志,2015,25(11):2420-2422.
[26]	蒲姝丽, 徐绣宇, 史静, 等. 碳青霉烯类非敏感阴沟肠杆菌耐药基因检测及流行病学分析[J]. 第三军医大学学报,2015,37(14):1442-1448.
[27]	海丰, 张鹏飞. 阴沟肠杆菌对氟喹诺酮类药物防耐药变异浓度的测定[J]. 现代检验医学杂志,2008,23(6):57-59.
[28]	夏蕊蕊, 国宪虎, 张玉臻, 等. 喹诺酮类药物及细菌对其耐药性机制研究进展[J]. 中国抗生素杂志,2010,35(4):255-261.

细菌名称（耐药类型）	总株数	多重耐药株数	检出率（%）
大肠埃希菌（产ESBLs）	2 909	969	33.31
肺炎克雷伯菌（产ESBLs）	715	186	26.01
奇异变形菌（产ESBLs）	98	38	38.78
鲍曼不动杆菌（CRAB）	98	53	54.08
铜绿假单胞菌（MDR/PDR-PA）	503	13	2.58
阴沟肠杆菌（MDREC）	260	94	36.15
金黄色葡萄球菌（MRSA）	278	41	14.75
凝固酶阴性的葡萄球菌（MRCNS）	260	76	29.23
合计	5 121	1 470	28.71

细菌名称（耐药类型）	总株数	多重耐药株数	检出率（%）
大肠埃希菌（产ESBLs）	2 909	969	33.31
肺炎克雷伯菌（产ESBLs）	715	186	26.01
奇异变形菌（产ESBLs）	98	38	38.78
鲍曼不动杆菌（CRAB）	98	53	54.08
铜绿假单胞菌（MDR/PDR-PA）	503	13	2.58
阴沟肠杆菌（MDREC）	260	94	36.15
金黄色葡萄球菌（MRSA）	278	41	14.75
凝固酶阴性的葡萄球菌（MRCNS）	260	76	29.23
合计	5 121	1 470	28.71

菌株	MRDOs	住院日（d）	总费用（元）	药品费用（元）	抗菌药费用（元）	化验费（元）	治疗费（元）
大肠埃希菌	是	19 ± 23	22 700 ± 30 815	6 216 ± 9 867	1 460 ± 1 875	1 776 ± 2 088	7 308 ± 13 613
	否	13 ± 12	12 896 ± 19 103	3 537 ± 5 663	958 ± 1 115	1 241 ± 1 140	3 947 ± 7 472
统计量		t = 6.89	t = 8.86	t = 7.74	t = 7.55	t = 7.39	t = 7.12
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.000
肺炎克雷伯菌	是	19 ± 16	31 960 ± 63 305	7 047 ± 12 264	1 639 ± 2 351	2 396 ± 4 677	14 714 ± 30 542
	否	15 ± 14	19 791 ± 28 663	5 946 ± 7 739	1 530 ± 2 247	1 652 ± 1 988	6 813 ± 13 874
统计量		t = 3.08	t = 3.49	t = 1.39	t = 0.55	t = 2.95	Z = 5.17^a
P值		0.030	0.001	0.170	0.590	0.003	< 0.001
奇异变形菌	是	25 ± 22	39 752 ± 42 443	10 294 ± 11 525	1 668 ± 1 779	3 515 ± 3 347	15 188 ± 19 659
	否	14 ± 9	16 812 ± 18 688	4 734 ± 4 955	712 ± 822	1 448 ± 1 088	5 490 ± 8 693
统计量		t = 3.24	t = 3.65	t = 3.27	t = 3.58	Z = 1.84^a	t = 3.33
P值		0.002	< 0.001	0.001	0.001	0.064	0.001
鲍曼不动杆菌	是	22 ± 21	33 916 ± 40 361	8 969 ± 11 198	1 380 ± 1 662	3 043 ± 3 080	12 665 ± 18 462
	否	16 ± 11	19 303 ± 22 431	5 257 ± 5 428	8 47 ± 1 032	1 641 ± 1 641	6 596 ± 10 512
统计量		t = 2.05	t = 2.28	t = 2.16	t = 1.95	t = 2.90	t = 2.05
P值		0.045	0.025	0.030	0.054	0.005	0.040
铜绿假单胞菌	是	64 ± 43	86 063 ± 59 388	15 040 ± 10 689	5 506 ± 2 000	3 182 ± 2 600	26 190 ± 22 210
	否	18 ± 17	23 958 ± 33 938	7 690 ± 9 947	2 024 ± 2 005	1 982 ± 2 347	7 950 ± 14 810
统计量		t = 9.03	t = 6.35	t = 2.63	t = 6.18	Z = 3.48^a	t = 4.32
P值		< 0.001	< 0.001	0.009	< 0.001	0.001	< 0.001
阴沟肠杆菌	是	29 ± 31	48 500 ± 71 569	11 053 ± 13 814	2 402 ± 2 839	4 292 ± 7 601	17 733 ± 28 394
	否	18 ± 19	23 741 ± 31 285	6 596 ± 9 117	1 590 ± 2 204	1 621 ± 1 825	7 754 ± 14 042
统计量		t = 3.39	t = 3.86	t = 3.13	t = 2.57	t = 4.32	t = 3.79
P值		0.001	< 0.001	0.002	0.010	< 0.001	< 0.001
金黄色葡萄球菌	是	21 ± 18	25 775 ± 31 339	8 192 ± 10 246	1 387 ± 1 239	1 795 ± 1 963	9 317 ± 13 795
	否	14 ± 15	14 663 ± 21 979	4 035 ± 6 898	879 ± 1 076	1 205 ± 996	4 321 ± 8 459
统计量		t = 2.68	t = 2.79	t = 3.29	t = 2.72	Z = 0.46^a	t = 3.14
P值		0.008	0.006	0.001	0.007	0.648	0.002
凝固酶阴性的葡萄球菌	是	26 ± 26	56 221 ± 83 996	12 723 ± 16 691	2 254 ± 2 451	5 081 ± 8 909	22 027 ± 33 265
	否	18 ± 16	20 024 ± 26 240	5 442 ± 7 552	1 318 ± 1 834	1 476 ± 1 508	6 410 ± 11 368
统计量		3.09	5.26	4.85	3.38	5.31	5.63
P值		0.002	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

菌株	MRDOs	住院日（d）	总费用（元）	药品费用（元）	抗菌药费用（元）	化验费（元）	治疗费（元）
大肠埃希菌	是	19 ± 23	22 700 ± 30 815	6 216 ± 9 867	1 460 ± 1 875	1 776 ± 2 088	7 308 ± 13 613
	否	13 ± 12	12 896 ± 19 103	3 537 ± 5 663	958 ± 1 115	1 241 ± 1 140	3 947 ± 7 472
统计量		t = 6.89	t = 8.86	t = 7.74	t = 7.55	t = 7.39	t = 7.12
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.000
肺炎克雷伯菌	是	19 ± 16	31 960 ± 63 305	7 047 ± 12 264	1 639 ± 2 351	2 396 ± 4 677	14 714 ± 30 542
	否	15 ± 14	19 791 ± 28 663	5 946 ± 7 739	1 530 ± 2 247	1 652 ± 1 988	6 813 ± 13 874
统计量		t = 3.08	t = 3.49	t = 1.39	t = 0.55	t = 2.95	Z = 5.17^a
P值		0.030	0.001	0.170	0.590	0.003	< 0.001
奇异变形菌	是	25 ± 22	39 752 ± 42 443	10 294 ± 11 525	1 668 ± 1 779	3 515 ± 3 347	15 188 ± 19 659
	否	14 ± 9	16 812 ± 18 688	4 734 ± 4 955	712 ± 822	1 448 ± 1 088	5 490 ± 8 693
统计量		t = 3.24	t = 3.65	t = 3.27	t = 3.58	Z = 1.84^a	t = 3.33
P值		0.002	< 0.001	0.001	0.001	0.064	0.001
鲍曼不动杆菌	是	22 ± 21	33 916 ± 40 361	8 969 ± 11 198	1 380 ± 1 662	3 043 ± 3 080	12 665 ± 18 462
	否	16 ± 11	19 303 ± 22 431	5 257 ± 5 428	8 47 ± 1 032	1 641 ± 1 641	6 596 ± 10 512
统计量		t = 2.05	t = 2.28	t = 2.16	t = 1.95	t = 2.90	t = 2.05
P值		0.045	0.025	0.030	0.054	0.005	0.040
铜绿假单胞菌	是	64 ± 43	86 063 ± 59 388	15 040 ± 10 689	5 506 ± 2 000	3 182 ± 2 600	26 190 ± 22 210
	否	18 ± 17	23 958 ± 33 938	7 690 ± 9 947	2 024 ± 2 005	1 982 ± 2 347	7 950 ± 14 810
统计量		t = 9.03	t = 6.35	t = 2.63	t = 6.18	Z = 3.48^a	t = 4.32
P值		< 0.001	< 0.001	0.009	< 0.001	0.001	< 0.001
阴沟肠杆菌	是	29 ± 31	48 500 ± 71 569	11 053 ± 13 814	2 402 ± 2 839	4 292 ± 7 601	17 733 ± 28 394
	否	18 ± 19	23 741 ± 31 285	6 596 ± 9 117	1 590 ± 2 204	1 621 ± 1 825	7 754 ± 14 042
统计量		t = 3.39	t = 3.86	t = 3.13	t = 2.57	t = 4.32	t = 3.79
P值		0.001	< 0.001	0.002	0.010	< 0.001	< 0.001
金黄色葡萄球菌	是	21 ± 18	25 775 ± 31 339	8 192 ± 10 246	1 387 ± 1 239	1 795 ± 1 963	9 317 ± 13 795
	否	14 ± 15	14 663 ± 21 979	4 035 ± 6 898	879 ± 1 076	1 205 ± 996	4 321 ± 8 459
统计量		t = 2.68	t = 2.79	t = 3.29	t = 2.72	Z = 0.46^a	t = 3.14
P值		0.008	0.006	0.001	0.007	0.648	0.002
凝固酶阴性的葡萄球菌	是	26 ± 26	56 221 ± 83 996	12 723 ± 16 691	2 254 ± 2 451	5 081 ± 8 909	22 027 ± 33 265
	否	18 ± 16	20 024 ± 26 240	5 442 ± 7 552	1 318 ± 1 834	1 476 ± 1 508	6 410 ± 11 368
统计量		3.09	5.26	4.85	3.38	5.31	5.63
P值		0.002	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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