Evans Heather L, Lefrak Shayna N, Lyman Jason, Smith Robert L, Chong Tae W, McElearney Shannon T, Schulman Alison R, Hughes Michael G, Raymond Daniel P, Pruett Timothy L, Sawyer Robert G
Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Crit Care Med. 2007 Jan;35(1):89-95. doi: 10.1097/01.CCM.0000251496.61520.75.
It is unclear that infections with Gram-negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization.
Retrospective observational cohort study of prospectively collected data.
University hospital surgical intensive care unit and ward.
Surgical patients with at least one GNR infection.
We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in-hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders.
Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 +/- 0.6 vs. 13.9 +/- 0.3), had higher median hospital costs ($80,500 vs. $29,604, p < .0001) and median antibiotic costs ($2,607 vs. $758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at $11,075; 95% confidence interval, $3,282-$20,099).
Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.
对至少一类主要抗生素耐药的革兰氏阴性菌（rGNR）感染对患者发病率的影响是否大于敏感菌株（sGNR）感染所致尚不清楚。我们希望检验rGNR感染与更高资源利用率相关的假设。
对前瞻性收集的数据进行回顾性观察队列研究。
大学医院外科重症监护病房和病房。
至少发生一次GNR感染的外科患者。
我们比较了接受rGNR感染治疗的入院患者和sGNR感染患者。主要结局为总住院费用和住院时间。其他结局包括抗生素治疗费用、院内死亡和重症监护病房住院时间。在对rGNR感染后与sGNR感染后的结局进行单因素分析后，建立了住院费用和住院时间的多变量线性回归模型以考虑潜在混杂因素。
有604例因至少一次GNR感染接受治疗的外科入院患者（符合疾病控制和预防中心标准）有费用数据，其中137例（23%）为rGNR感染。rGNR感染的入院患者在感染时病情严重程度更高（急性生理与慢性健康状况评估II评分，17.6±0.6对13.9±0.3），中位住院费用更高（80,500美元对29,604美元，p<0.0001），中位抗生素费用更高（2,607美元对758美元，p<0.0001），中位住院时间更长（29天对13天，p<0.0001），中位重症监护病房住院时间更长（13天对1天，p<0.0001）。入院后7天内发生rGNR感染可独立预测住院费用增加（估计中位住院费用增量为11,075美元；95%置信区间，3,282美元至20,099美元）。
早期rGNR感染与高经济负担相关，这部分与敏感菌感染相比抗生素使用增加有关。应努力控制抗生素的过度使用。
