Department of Infection Control, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Hosp Infect. 2010 Dec;76(4):304-7. doi: 10.1016/j.jhin.2010.07.003. Epub 2010 Sep 15.
Healthcare-associated infection (HCAI) following open heart surgery is not only a major cause of mortality and morbidity, but also carries higher costs. There are limited data on the additional costs due to HCAI in non-western countries. To estimate the direct cost of the four most common HCAIs in an Iranian sample, we studied 1191 patients admitted for elective open heart surgery. HCAIs were defined using the National Nosocomial Infections Surveillance criteria (Centers for Disease Control and Prevention, Atlanta, GA, USA). The financial costs of length of stay per day in hospital, paraclinical services, medications, instruments, and operating room were provided by the hospital's finance department. The contribution of HCAI to excess direct medical costs in patients with HCAI was assessed by multivariable linear regression. In the study population, the mean age was 57.3±11.9 years, 857 (72.0%) were men, and 64 (5.4%) developed HCAI. In total there were 73 infections of which the most common was surgical site infection (49.3%), followed by urinary tract infection (20.5%), bloodstream infection (16.5%), and pneumonia (13.7%). After adjustment for other confounders HCAI remained associated with excess direct medical costs (β=1707.06, SE=90.84; P < 0.001). The medical costs in patients with HCAI were almost twice those in patients without HCAI. More than half of the excess cost was attributable to prolonged hospitalisation.
心脏手术后发生的医源性感染（HCAI）不仅是导致死亡率和发病率的主要原因，而且还会带来更高的成本。在非西方国家，关于 HCAI 导致的额外成本的数据有限。为了估计伊朗样本中四种最常见 HCAI 的直接成本，我们研究了 1191 名接受择期心脏手术的患者。HCAI 是使用国家医院感染监测标准（美国亚特兰大疾病控制与预防中心）定义的。医院财务部提供了每天住院、辅助检查、药物、器械和手术室费用的住院费用。多变量线性回归评估了 HCAI 对 HCAI 患者过度医疗直接费用的贡献。在研究人群中，平均年龄为 57.3±11.9 岁，857 名（72.0%）为男性，64 名（5.4%）发生了 HCAI。共有 73 例感染，其中最常见的是手术部位感染（49.3%），其次是尿路感染（20.5%）、血流感染（16.5%）和肺炎（13.7%）。在调整其他混杂因素后，HCAI 仍与过度医疗直接费用相关（β=1707.06，SE=90.84；P<0.001）。HCAI 患者的医疗费用几乎是无 HCAI 患者的两倍。超过一半的超额费用归因于住院时间延长。
