OBJECTIVE To analyze the prevalence of hospital-associated carbapenem-resistant Enterobacter (CRE) infections among the elderly intensive care unit (ICU) patients with respiratory system diseases based on the Chinese healthcare security diagnosis-related groups (CHS-DRG) and the case mix index (CMI) and assess the economic burden and consumption of healthcare insurance funds.

METHODS The key departments with high isolation rate of CRE and high incidence of hospital-associated infections were found out by using CMI. The data were collected from 56 elderly patients with major diagnostic category E (MDCE) who had hospital-associated Enterobacter infection and were treated in 10 ICUs of the Second People's Hospital of Changzhou from 2021 to 2023. The length of hospital stay, economic burden and consumption of healthcare insurance funds were observed and compared between the CRE infection group and the carbapenem-sensitive Enterobacter (CSE) infection group.

RESULTS The general ICU (Yanghu campus) ranked the top 3 isolation rate of CRE and incidence of hospital-associated infections after the adjustment of CMI value. EJ1 (other respiratory system surgeries) and ES2 (respiratory system infection/inflammation) were the core codes of major Enterobacter infection. The average length of hospital stay of the CRE group was 10 days larger than the CSE group, the self-funded amount was 20, 777.65 yuan more in the CRE group than in the CSE group; the consumption of healthcare insurance funds was 39, 631.64 yuan more in the CRE group than in the CSE group (P < 0.05). Of the patients encoded with ES2, the average length of hospital stay was 6.5 days more in the CRE group than in the CSE group, and the fund expense on payment of severe diseases was greater in the CRE group than in the CSE group (P < 0.05).

CONCLUSIONS The CRE infection may increase the length of hospital stay, economic burden and consumption of healthcare insurance funds of the elderly ICU patients with respiratory system diseases. Under the CHS-DRG payment mode, it is necessary to take targeted prevention and control strategies according to the characteristics of patients with different DRG codes so as to control the wide spread of CRE.