呼吸机相关性肺炎碳青霉烯类抗菌药物耐药菌感染经济损失

Economic loss due to ventilator-associated pneumonia caused by carbapenem-resistant bacteria

    摘要
  • 摘要: 目的 研究呼吸机相关性肺炎(VAP)碳青霉烯类抗菌药物耐药菌医院感染对住院日、住院费用和预后的影响,了解其经济损失。方法 回顾性调查2017年1月－2019年11月贵州医科大学第三附属医院碳青霉烯类抗菌药物耐药菌VAP与同种碳青霉烯类抗菌药物敏感菌VAP患者基本情况、感染特征与相关因素等临床资料,采用倾向性评分匹配(PSM)法对碳青霉烯类抗菌药物耐药菌VAP与同种病原菌碳青霉烯类抗菌药物敏感菌VAP患者进行1∶1匹配,比较碳青霉烯类抗菌药物耐药菌VAP患者与碳青霉烯类抗菌药物敏感菌VAP住院日、住院费用和预后差异。结果 耐碳青酶烯类抗菌药物病原菌VAP发生率为7.32%,其中耐碳青霉烯鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌VAP发生率分别为2.36%、1.98%、1.60%、1.37%。PSM并均衡性检验后,碳青霉烯类抗菌药物耐药菌VAP患者平均住院日较碳青霉烯类抗菌药物敏感菌VAP患者住院时间长22 d(P＜0.001),平均住院总费用增加43 894.09元(P＜0.001)。结论 碳青霉烯类抗菌药物耐药菌VAP可增加患者医疗费用与经济损失,增加住院时间,且预后较差,临床应加强碳青霉烯类抗菌药物管理,减少碳青霉烯类抗菌药物耐药菌VAP。

     

    Abstract: OBJECTIVE To explore the influence of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant bacteria on length of hospital stay, hospitalization cost and prognosis and understand the economic loss. METHODS A retrospective survey was conducted for the clinical data of the patients with carbapenem-resistant bacteria VAP and carbapenem-sensitive bacteria VAP who were treated in the Third Affiliated Hospital of Guizhou Medical University from Jan 2017 to Nov 2019, including the baseline data, characteristics of infection and related factors. A 1:1 matching was carried out for the patients with VAP caused by carbapenem-resistant bacteria and the patients with VAP caused by the same species of carbapenem-resistant bacteria by using propensity score matching (PSM) method. The length of hospital stay, hospitalization cost and prognosis were observed and compared between the patients with carbapenem-resistant bacteria pneumonia and the patients with carbapenem-sensitive bacteria pneumonia. RESULTS The incidence rate of VAP caused by the carbapenem-resistant pathogens was 7.32%, the incidence rate of carbapenem-resistant Acinetobacter baumannii VAP was 2.36%, the incidence rate of carbapenem-resistant Pseudomonas aeruginosa VAP was 1.98%, the incidence rate of carbapenem-resistant Klebsiella pneumoniae VAP was 1.60%, and the incidence rate of carbapenem-resistant Escherichia coli VAP was 1.37%. The PSM and balance test showed that the average length of hospital stay of the patients with carbapenem-resistant bacteria VAP was 22 days longer than that of the patients with carbapenem-sensitive bacteria VAP (P＜0.001), and the average hospitalization cost in total was increased by 43 894.09 yuan (P＜0.001). CONCLUSION The VAP caused by the carbapenem-resistant bacteria may lead to the increase of medical cost and economic loss, extension of length of hospital stay and poor prognosis. It is necessary for the hospital to strengthen the management of carbapenems antibiotics and reduce the incidence of carbapenem-resistant bacteria VAP.

     

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