Eber Michael R, Laxminarayan Ramanan, Perencevich Eli N, Malani Anup
Center for Disease Dynamics, Economics, & Policy, Resources for the Future, 1616 P Street NW, Washington, DC 20036, USA.
Arch Intern Med. 2010 Feb 22;170(4):347-53. doi: 10.1001/archinternmed.2009.509.
Health care-associated infections affect 1.7 million hospitalizations each year, but the clinical and economic costs attributable to these infections are poorly understood. Reliable estimates of these costs are needed to efficiently target limited resources for the greatest public health benefit.
Hospital discharge records from the Nationwide Inpatient Sample database were used to identify sepsis and pneumonia cases among 69 million discharges from hospitals in 40 US states between 1998 and 2006. Community-acquired infections were excluded using criteria adapted from previous studies. Because these criteria may not exclude all community-acquired infections, outcomes were examined separately for cases associated with invasive procedures, which were unlikely to result from preexisting infections. Attributable hospital length of stay, hospital costs, and crude in-hospital mortality were estimated from discharge records using a multivariate matching analysis and a supplementary regression analysis. These models controlled for patient diagnoses, procedures, comorbidities, demographics, and length of stay before infection.
In cases associated with invasive surgery, attributable mean length of stay was 10.9 days, costs were $32 900, and mortality was 19.5% for sepsis; corresponding values for pneumonia were 14.0 days, $46 400, and 11.4%, respectively (P < .001). In cases not associated with invasive surgery, attributable mean length of stay, costs, and mortality were estimated to be 1.9 to 6.0 days, $5800 to $12 700, and 11.7% to 16.0% for sepsis and 3.7 to 9.7 days, $11 100 to $22 300, and 4.6% to 10.3% for pneumonia (P < .001).
Health care-associated sepsis and pneumonia impose substantial clinical and economic costs.
医疗保健相关感染每年影响170万住院患者，但这些感染所致的临床和经济成本尚不清楚。需要对这些成本进行可靠估计，以便有效地将有限资源用于实现最大的公共卫生效益。
利用全国住院患者样本数据库中的医院出院记录，在1998年至2006年期间美国40个州的6900万例出院患者中识别败血症和肺炎病例。采用先前研究改编的标准排除社区获得性感染。由于这些标准可能无法排除所有社区获得性感染，因此对与侵入性操作相关的病例的结果进行单独检查，这些操作不太可能由先前存在的感染引起。使用多变量匹配分析和补充回归分析，从出院记录中估计可归因的住院时间、医院成本和粗住院死亡率。这些模型控制了患者的诊断、操作、合并症、人口统计学特征以及感染前的住院时间。
在与侵入性手术相关的病例中，败血症的可归因平均住院时间为10.9天，成本为32900美元，死亡率为19.5%；肺炎的相应值分别为14.0天、46400美元和11.4%（P < 0.001）。在与侵入性手术无关的病例中，败血症的可归因平均住院时间、成本和死亡率估计分别为1.9至6.0天、5800至12700美元和11.7%至16.0%，肺炎为3.7至9.7天、11100至22300美元和4.6%至10.3%（P < 0.001）。
医疗保健相关的败血症和肺炎会带来巨大的临床和经济成本。
