OBJECTIVE  To explore the epidemiological characteristics and economic burden of hospital-associated infections in the intensive care unit （ICU）, and to investigate precise prevention and control pathways within the diagnosis-related groups （DRG） framework.

METHODS  A retrospective analysis was conducted on the clinical data of 2 070 ICU patients from Shanxi Bethune Hospital from Jan. 2024 to Dec. 2024. Multivariate logistic regression analysis was employed to identify risk factors for infection. A quantitative comparative analysis of medical resource consumption patterns associated with infection was conducted in combination with DRG grouping and cost data.

RESULTS  The overall incidence rate of hospital-associated infections in the ICU was 15.75% （326/2 070）. Lower respiratory tract infections （65.34%） and gram-negative bacterial infections （70.73%, primarily Klebsiella pneumoniae and Acinetobacter baumannii） constituted the core clinical burden. Key risk factors included a hospital stay ≥15 days （OR=3.329）, antimicrobial use ≥20 days （OR=3.318） and vascular catheterization （OR=2.671）. DRG risk stratification patterns revealed that patients in the extracorporeal membrane oxygenation or total artificial heart implantation group （AH19 group） and those undergoing prolonged ventilator therapy （AH29 group） had infection rates up to 50.00% and 40.61%, respectively. Economic analysis showed that infections resulted in a threefold increase in the median total hospitalization costs （RMB 64 146.29 vs. RMB 14 615.55） and a fivefold increase in antimicrobial costs （RMB 1 152.92 vs. RMB 189.80）. Lower respiratory tract infections were the primary contributor to the overall burden, attributable to their high incidence.

CONCLUSIONS  A triple pathway should be established, comprising targeted interventions for high-risk DRG groups （AH19/AH29）, reduction of invasive procedures and enhanced management of gram-negative bacterial infections, with a prevention–control effectiveness–payment linkage mechanism as the safeguard.