Vandijck Dominique M, Depaemelaere Mieke, Labeau Sonia O, Depuydt Pieter O, Annemans Lieven, Buyle Franky M, Oeyen Sandra, Colpaert Kirsten E, Peleman Renaat P, Blot Stijn I, Decruyenaere Johan M
Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, Ghent, Belgium.
Int J Antimicrob Agents. 2008 Feb;31(2):161-5. doi: 10.1016/j.ijantimicag.2007.10.015.
This study analysed daily antimicrobial costs of Intensive Care Unit (ICU)-acquired, laboratory-confirmed bloodstream infection (BSI) per patient admitted to the ICU of a university hospital, based on prospectively collected data over a 4-year period (2003-2006). Costs were calculated based on the price of the agent(s) initiated on the first day of appropriate treatment and according to: (i) focus of infection; (ii) pathogen; and (iii) antimicrobial agent. The study included 310 adult patients who developed 446 BSI episodes. Mean overall daily antimicrobial cost was euro114.25. Daily antimicrobial cost was most expensive for BSIs with unknown focus (euro137.70), followed by catheter-related (euro122.73), pulmonary (euro112.80), abdominal (euro98.00), wound (euro89.21), urinary (euro87.85) and other inciting focuses (euro81.59). Coagulase-negative staphylococci were the most prevalent pathogens isolated. Treatment of BSIs caused by Candida spp. was the most costly. The daily antimicrobial costs per infected patient with multidrug-resistant BSI was ca. 50% higher compared with those without (euro165.09 vs. euro82.67; P<0.001). Among the total of 852 prescriptions, beta-lactam antibiotics accounted for approximately one-third of the overall daily cost of antimicrobial agents. The antibiotic cost associated with ICU-acquired, laboratory-confirmed BSI is significant and should be reduced by implementing infection control measures and preventive strategies.
本研究基于一所大学医院重症监护病房（ICU）前瞻性收集的4年（2003 - 2006年）数据，分析了入住该ICU的患者发生的、经实验室确诊的ICU获得性血流感染（BSI）的每日抗菌药物费用。费用根据在适当治疗第一天开始使用的药物价格，并依据以下因素计算：（i）感染部位；（ii）病原体；（iii）抗菌药物。该研究纳入了310例发生446次BSI发作的成年患者。平均每日总体抗菌药物费用为114.25欧元。感染部位不明的BSI每日抗菌药物费用最高（137.70欧元），其次是导管相关感染（122.73欧元）、肺部感染（112.80欧元）、腹部感染（98.00欧元）、伤口感染（89.21欧元）、泌尿系统感染（87.85欧元）和其他感染源（81.59欧元）。凝固酶阴性葡萄球菌是分离出的最常见病原体。由念珠菌属引起的BSI治疗费用最高。与非多重耐药BSI感染患者相比，多重耐药BSI感染患者的每日抗菌药物费用约高50%（165.09欧元对82.67欧元；P<0.001）。在总共852张处方中，β-内酰胺类抗生素约占抗菌药物每日总费用的三分之一。与ICU获得性、经实验室确诊的BSI相关的抗生素费用很高，应通过实施感染控制措施和预防策略来降低。
