Orsi Giovanni Battista, Di Stefano Lidia, Noah Norman
Institute of Hygiene, University La Sapienza Rome, Italy.
Infect Control Hosp Epidemiol. 2002 Apr;23(4):190-7. doi: 10.1086/502034.
To determine increased hospital stay and direct costs attributable to hospital-acquired, laboratory-confirmed bloodstream infection (BSI), and to evaluate the matching variable length of stay (LOS).
Retrospective (historical) cohort study with 1:2 matching in intensive care units and surgical wards.
A 2,000-bed university hospital in Rome, Italy.
All patients admitted between January 1994 and June 1995 who had hospital-acquired, laboratory-confirmed BSI were considered cases; all others were eligible as controls.
Two controls (A and B) were selected per case in a stepwise fashion. Controls in group A were selected according to the following six criteria: ward, gender, age, diagnosis, central venous catheter, and LOS equal to the interval from admission to infection in a matched case +/- 20% (LOS +/- 20%). Controls in group B were selected according to the first five criteria, but excluded LOS +/- 20%.
One hundred five of 108 patients were each matched with two controls. The matching appropriateness score was greater than 90%. With the use of controls in groups A and B, the case-fatality rates attributable to hospital-acquired, laboratory-confirmed BSI were 35.2% and 40.9%, respectively; the estimated risk ratios for death were 2.60 and 3.52 (P = .0001), respectively. The increased hospital stay per case attributable to hospital-acquired, laboratory-confirmed BSI was 19.1 (mean) and 13.0 (median) days for matched pairs in control group A and 19.9 (mean) and 15.0 (median) days for matched pairs in control group B. With controls in group A, the cost of increased hospital stay per patient attributable to hospital-acquired, laboratory-confirmed BSI was Euro 15,413. The additional cost per patient due to treatment was Euro 943, making the overall direct cost Euro 16,356 per case.
This study should make it possible to estimate the cost of hospital-acquired, laboratory-confirmed BSI in most hospitals after adjusting for incidence rate. It also confirmed the use of LOS +/- 20% as a matching variable to limit overestimation of increased hospital stay. To our knowledge, this is among the first such studies in Europe.
确定因医院获得性、实验室确诊的血流感染（BSI）导致的住院时间延长和直接费用，并评估匹配的可变住院时间（LOS）。
在重症监护病房和外科病房进行1:2匹配的回顾性（历史性）队列研究。
意大利罗马一家拥有2000张床位的大学医院。
1994年1月至1995年6月期间入院且患有医院获得性、实验室确诊BSI的所有患者被视为病例；所有其他患者符合作为对照的条件。
每例病例以逐步方式选择两个对照（A组和B组）。A组对照根据以下六个标准选择：病房、性别、年龄、诊断、中心静脉导管以及住院时间等于匹配病例从入院到感染的间隔时间±20%（LOS±20%）。B组对照根据前五个标准选择，但排除LOS±20%。
108例患者中的105例均与两个对照进行了匹配。匹配适宜性评分大于90%。使用A组和B组对照时，因医院获得性、实验室确诊BSI导致的病死率分别为35.2%和40.9%；估计的死亡风险比分别为2.60和3.52（P = .0001）。A组匹配对中，因医院获得性、实验室确诊BSI导致的每例病例住院时间延长平均为19.1天，中位数为13.0天；B组匹配对中分别为19.9天和15.0天。使用A组对照时，因医院获得性、实验室确诊BSI导致的每名患者住院时间延长的费用为15413欧元。治疗导致的每名患者额外费用为943欧元，使每例病例的总体直接费用为16356欧元。
本研究应能够在调整发病率后估计大多数医院中因医院获得性、实验室确诊BSI产生的费用。它还证实了使用LOS±20%作为匹配变量以限制对住院时间延长的高估。据我们所知，这是欧洲首批此类研究之一。
