摘要
目的本研究旨在分析老年多重耐药菌(MDRO)医院感染患者的直接经济负担,为构建精准防控策略提供循证依据。方法收集某三级甲等医院2023年1月—2024年12月老年MDRO医院感染患者,采用倾向性评分匹配(PSM)平衡组间混杂因素后,对比MDRO组与非MDRO组的住院时长与总费用差异。结果共纳入234例患者,经PSM后MDRO组和非MDRO组患者各75例。单因素分析显示,MDRO组在机械通气、近期医疗暴露史、抗菌药物暴露史、侵入性操作史、抗菌药物耐药率方面均高于非MDRO组(均P<0.05)。经济负担方面,MDRO组住院时长较非MDRO组延长(25 d VS 22 d;U=2249.5,P=0.034),总费用中位数也更高(37779.0元VS 15075.7元;U=1832.5,P<0.001)。除住院自付金额与手术治疗费外,MDRO组其余各项费用均高于非MDRO组(均P<0.05)。感染部位方面,MDRO组在呼吸道与泌尿道感染的经济负担上高于非MDRO组(均P<0.05)。Gamma回归显示,MDRO感染(OR=1.76,95%CI:1.10~2.89),鲍曼不动杆菌感染(OR=1.53,95%CI:1.04~2.28),住院时长(OR=1.02,95%CI:1.01~1.04),入住ICU(OR=1.76,95%CI:1.13~2.74)为医疗费用独立影响因素(均P<0.05)。分位数回归提示,MDRO感染在低中分位点(τ=0.25,β=14409.75;τ=0.50,β=17436.48)均呈正效应,住院时长(τ=0.50,β=1423.15;τ=0.75:β=1176.13)与入住ICU(τ=0.50,β=25762.75;τ=0.75,β=51689.76)则在中高分位点增加费用(均P<0.05)。结论MDRO医院感染给老年患者带来沉重经济负担,医疗机构应构建融合抗菌药物管理、早期诊断与重点防控的整合性体系,通过多学科质量改进有效控制医疗费用。
Objective To analyze the direct economic burden of elderly patients with healthcare-associated infection(HAI)caused by multidrug-resistant ogranism(MDRO),and provide evidence-based support for constructing precise prevention and control strategies.Methods Data of elderly patients with MDRO HAI from January 2023 to December 2024 in a tertiary first-class hospital were collected.After using propensity score matching(PSM)to balance confounding factors among groups,differences in length of hospital stay and total expense between MDRO group and non-MDRO group were compared.Results A total of 234 patients were included in analysis,with 75 in MDRO group and 75 in non-MDRO group after PSM.Univariate analysis showed that MDRO group were all higher than non-MDRO group in terms of mechanical ventilation,histories of recent medical exposure,antimicrobial exposure,and invasive procedure history,as well as antimicrobial resistance rate(all P<0.05).In terms of economic burden,length of hospital stay in MDRO group was longer than non-MDRO group(25 vs 22 days;U=2249.5,P=0.034),and the median of total expense was also higher(37779.0 vs 15075.7 Yuan;U=1832.5,P<0.001).Except for self-paid hospitalization expense and surgical treatment expense,other expense in MDRO group were all higher than non-MDRO group(all P<0.05).In terms of infection site,MDRO group had higher economic burden on respiratory tract and urinary tract infections than non-MDRO group(both P<0.05).Gamma regression analysis showed that MDRO infection(OR=1.76,95%CI:1.10-2.89),Acinetobacter baumannii infection(OR=1.53,95%CI:1.04-2.28),length of hospital stay(OR=1.02,95%CI:1.01-1.04),and admission to intensive care unit(ICU)(OR=1.76,95%CI:1.13-2.74)were all independent factors affecting medical expense(all P<0.05).Quantile regression revealed that MDRO infection presented positive effect at the low and middle percentile(τ=0.25,β=14409.75;τ=0.50,β=17436.48).Length of hospital stay(τ=0.50,β=1423.15;τ=0.75,β=1176.13)and admission to ICU(τ=0.50,β=25762.75;τ=0.75,β=51689.76)increased the expense at the middle and high percentile(both P<0.05).Conclusion MDRO HAI bring about heavy economic burden on elderly patients.Medical institutions should establish an integrated system that integrates antimicrobial management,early diagnosis,and key prevention and control,so as to effectively control medical expense through multidisciplinary quality improvement.
作者
何艳萍
祁涵之
潘颖颖
庄建文
屠雪峰
罗梦佳
邹利娜
朱熠
HE Yanping;QI Hanzhi;PAN Yingying;ZHUANG Jianwen;TU Xuefeng;LUO Mengjia;ZOU Lina;ZHU Yi(Department of Preventive Medicine,Shihezi University School of Medicine,Shihezi 832000,China;Office of Healthcare-associated Infection Management,Xinjiang Production and Construction Corps Hospital/Second Affiliated Hospital of Shihezi University School of Medicine,Urumqi 830000,China)
出处
《中国感染控制杂志》
北大核心
2026年第2期222-228,共7页
Chinese Journal of Infection Control
基金
兵团科技计划项目(2023CB001)
2023年兵团英才支持青年项目(2023AB18-06)。
关键词
多重耐药菌
医院感染
老年患者
经济负担评价
multidrug-resistant organism
healthcare-associated infection
elderly patient
economic burden assessment
