Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri, USA.
Infect Control Hosp Epidemiol. 2010 Jan;31(1):28-35. doi: 10.1086/649020.
Vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs) are associated with increased morbidity and mortality.
To determine the hospital costs and length of stay attributable to VRE BSI and vancomycin-sensitive Enterococcus (VSE) BSI and the independent effect of vancomycin resistance on hospital costs.
A retrospective cohort study was conducted of 21,154 nonsurgical patients admitted to an academic medical center during the period from 2002 through 2003. Using administrative data, attributable hospital costs (adjusted for inflation to 2007 US dollars) and length of stay were estimated with multivariate generalized least-squares (GLS) models and propensity score-matched pairs.
The cohort included 94 patients with VRE BSI and 182 patients with VSE BSI. After adjustment for demographics, comorbidities, procedures, nonenterococcal BSI, and early mortality, the costs attributable to VRE BSI were $4,479 (95% confidence interval [CI], $3,500-$5,732) in the standard GLS model and $4,036 (95% CI, $3,170-$5,140) in the propensity score-weighted GLS model, and the costs attributable to VSE BSI were $2,250 (95% CI, $1,758-$2,880) in the standard GLS model and $2,023 (95% CI, $1,588-$2,575) in the propensity score-weighted GLS model. The median values of the difference in costs between matched pairs were $9,949 (95% CI, $1,579-$24,693) for VRE BSI and $5,282 (95% CI, $2,042-$8,043) for VSE BSI. The costs attributable to vancomycin resistance were $1,713 (95% CI, $1,338-$2,192) in the standard GLS model and $1,546 (95% CI, $1,214-$1,968) in the propensity score-weighted GLS model. Depending on the statistical method used, attributable length of stay estimates ranged from 2.2 to 3.5 days for patients with VRE BSI and from 1.1 to 2.2 days for patients with VSE BSI.
VRE BSI and VSE BSI were independently associated with increased hospital costs and increased length of stay. Vancomycin resistance was associated with increased costs.
耐万古霉素肠球菌（VRE）血流感染（BSI）与发病率和死亡率的增加有关。
确定 VRE BSI 和万古霉素敏感肠球菌（VSE）BSI 导致的医院成本和住院时间，并确定万古霉素耐药对医院成本的独立影响。
对 2002 年至 2003 年期间在一家学术医疗中心住院的 21154 例非手术患者进行回顾性队列研究。使用行政数据，通过多变量广义最小二乘法（GLS）模型和倾向评分匹配对调整通胀后（至 2007 年美元）的归因医院成本和住院时间进行估计。
该队列包括 94 例 VRE BSI 患者和 182 例 VSE BSI 患者。在调整人口统计学、合并症、手术、非肠球菌性 BSI 和早期死亡率后，标准 GLS 模型中 VRE BSI 的归因成本为 4479 美元（95%置信区间[CI]，3500-5732 美元），倾向评分加权 GLS 模型中为 4036 美元（95%CI，3170-5140 美元），标准 GLS 模型中 VSE BSI 的归因成本为 2250 美元（95%CI，1758-2880 美元），而倾向评分加权 GLS 模型中为 2023 美元（95%CI，1588-2575 美元）。匹配对之间成本差异的中位数为 VRE BSI 为 9949 美元（95%CI，1579-24693 美元），VSE BSI 为 5282 美元（95%CI，2042-8043 美元）。标准 GLS 模型中万古霉素耐药的归因成本为 1713 美元（95%CI，1338-2192 美元），倾向评分加权 GLS 模型中为 1546 美元（95%CI，1214-1968 美元）。根据使用的统计方法，VRE BSI 患者的归因住院时间估计值在 2.2 至 3.5 天之间，VSE BSI 患者的归因住院时间估计值在 1.1 至 2.2 天之间。
VRE BSI 和 VSE BSI 与医院成本增加和住院时间延长独立相关。万古霉素耐药与成本增加有关。
