Zhou Qing-tao, He Bei, Zhu Hong
Peking University Third Hospital, Beijing, China.
Value Health. 2009 Jan-Feb;12(1):40-6. doi: 10.1111/j.1524-4733.2008.00410.x. Epub 2008 Jul 10.
The cost of treating community-acquired pneumonia (CAP) in China is a heavy economic burden for the society.
To investigate the costs of hospitalization of low-risk CAP patients and how hospitalization costs can be reduced through proper usage of hospital resources.
Two hundred thirty-six patients with low-risk CAP who were hospitalized between January 2000 and December 2005 in a 1161-bed tertiary care teaching hospital were included in a retrospective cohort study. Their hospitalization costs and antibiotic therapy were analyzed. General linear model was utilized to determine correlative variables associated with total hospital costs.
The median length of hospital stay was 12 days and the median duration of intravenous (IV) antibiotic therapy was 10 days, they were correlated significantly (P = 0.000, r = 0.81). The median total hospital cost was $556.50 (mean $705.60), of which 48.9% was for drugs, 21.9% for laboratory tests, 8.6% for radiology, 6.5% for medical staff, 6.3% for hospital beds, and 5.3% for examination. General linear model analysis determined that duration of IV antibiotic therapy, Pneumonia Severity Index class, age, and initial empirical antibiotic therapy failure were correlative factors of total hospital costs. Pathogens were identified in 106 patients (44.9%), Mycoplasma pneumoniae was the most common pathogen (19.9%), followed by Streptococcus pneumoniae (8.5%), and Haemophilus influenza (5.5%). The majority of patients accepted initial empirical beta-lactam (37.3%) or fluoroquinolone (30.9%) monotherapy, the empirical treatment failure rates were 20.5% and 5.5%, respectively.
Efforts to reduce duration of IV antibiotic therapy will have the most profound effect on reducing total hospital costs of low-risk CAP. The atypical pathogens should be considered for initial empirical antibiotics in low-risk CAP therapy in China.
在中国，治疗社区获得性肺炎（CAP）的费用给社会带来了沉重的经济负担。
调查低风险CAP患者的住院费用，以及如何通过合理利用医院资源来降低住院费用。
一项回顾性队列研究纳入了2000年1月至2005年12月期间在一家拥有1161张床位的三级护理教学医院住院的236例低风险CAP患者。分析了他们的住院费用和抗生素治疗情况。采用一般线性模型确定与总住院费用相关的变量。
中位住院时间为12天，静脉（IV）抗生素治疗的中位持续时间为10天，二者显著相关（P = 0.000，r = 0.81）。中位总住院费用为556.50美元（平均705.60美元），其中48.9%用于药物，21.9%用于实验室检查，8.6%用于放射学检查，6.5%用于医务人员，6.3%用于病床，5.3%用于检查。一般线性模型分析确定，IV抗生素治疗持续时间、肺炎严重程度指数分级、年龄和初始经验性抗生素治疗失败是总住院费用的相关因素。106例患者（44.9%）鉴定出病原体，肺炎支原体是最常见的病原体（19.9%），其次是肺炎链球菌（8.5%）和流感嗜血杆菌（5.5%）。大多数患者接受初始经验性β-内酰胺类（37.3%）或氟喹诺酮类（30.9%）单药治疗，经验性治疗失败率分别为20.5%和5.5%。
努力缩短静脉抗生素治疗持续时间对降低低风险CAP的总住院费用将产生最深远的影响。在中国，低风险CAP治疗的初始经验性抗生素应考虑非典型病原体。
