Webb M, Riley L W, Roberts R B
Division of Infectious Diseases, School of Public Health, University of California, Berkeley, CA, USA.
Clin Infect Dis. 2001 Aug 15;33(4):445-52. doi: 10.1086/321891. Epub 2001 Jul 11.
The increase in costs of hospitalization for patients with drug-resistant infection may be associated with drug resistance itself or with the severity of the underlying illness that predisposes patients to acquire the drug-resistant infection. To address this issue, risk factors and cost of hospitalization were compared for patients infected or colonized with vancomycin-susceptible Enterococcus faecium (VSEF) or vancomycin-resistant E. faecium (VREF) in a large tertiary-care hospital in New York City. From January 1995 through December 1996, 157 patients with VSEF and 262 patients with VREF were identified. CMI (case-mix index) was assigned to each patient as a measure of severity of illness, with a CMI of 1 considered to represent illness of average severity. For all patients who were assigned a CMI of <3, the cost per day of hospitalization for patients with VREF was significantly greater than that for patients with VSEF. However, for patients with a CMI of >3, there was no difference between cost of hospitalization for patients with VREF and that for patients with VSEF. These observations indicate that, although vancomycin resistance is associated with an increased cost of hospitalization for less severely ill patients with VREF, patients with severe underlying illness, regardless of vancomycin resistance, incur similar hospitalization costs.
耐药感染患者住院费用的增加可能与耐药性本身有关，也可能与使患者易患耐药感染的基础疾病的严重程度有关。为解决这一问题，在纽约市一家大型三级护理医院中，对感染或定植万古霉素敏感粪肠球菌（VSEF）或万古霉素耐药粪肠球菌（VREF）的患者的危险因素和住院费用进行了比较。从1995年1月至1996年12月，共识别出157例VSEF患者和262例VREF患者。将病例组合指数（CMI）分配给每位患者作为疾病严重程度的衡量指标，CMI为1被认为代表平均严重程度的疾病。对于所有CMI<3的患者，VREF患者的每日住院费用显著高于VSEF患者。然而，对于CMI>3的患者，VREF患者和VSEF患者的住院费用没有差异。这些观察结果表明，虽然万古霉素耐药性与病情较轻的VREF患者住院费用增加有关，但基础疾病严重的患者，无论是否存在万古霉素耐药性，住院费用相似。
