Department of Medicine, National University Health System, Singapore.
J Hosp Infect. 2011 May;78(1):36-40. doi: 10.1016/j.jhin.2010.10.016. Epub 2011 Jan 26.
We performed a prospective matched case-control study, with six-month follow-up for discharged subjects, to evaluate the direct clinical and financial impact of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) infections in Singaporean hospitals. Consecutive nosocomial MRSA-infected cases at both tertiary public sector hospitals in Singapore were matched for age, specialty service, major surgical procedure (if applicable) and Charlson comorbidity index with up to two non-infected controls each. Chart reviews and subject interviews were performed during hospitalisation and also upon six months post-discharge for survivors. The outcomes analysed were: mortality, length of hospitalisation (LOS), healthcare-associated financial costs, and health-related quality of life. The last was evaluated via an interviewer-administered EuroQol-5D questionnaire on discharge, with conversion to a single health state summary index. Attributable outcomes were ascertained by conditional logistic and linear regression. There were 181 cases and 351 controls. MRSA infection was independently associated with in-hospital death [14.4% vs 1.4%; odds ratio (OR): 5.54; 95% confidence interval (CI): 1.63-18.79, P=0.006], longer LOS (median of 32 days vs 7 days; coefficient: 1.21; 95% CI: 1.02-1.40, P<0.001), higher hospitalisation costs (median of US$18,129.89 vs US$4,490.47; coefficient: 1.14; 95% CI: 0.93-1.35; P<0.001), higher post-discharge healthcare-associated financial costs (median of US$337.24 vs US$259.29; coefficient: 0.39; 95% CI: 0.06-0.72; P=0.021), and poorer health-related quality of life (coefficient: -0.14; 95% CI: -0.21 to -0.08; P<0.001). Outcomes were not significantly different between both hospitals. The attributable individual, institutional and societal impact of MRSA infections is considerable in Singapore. Preventing such infections will result in substantial improvements in patient outcomes and healthcare delivery.
我们进行了一项前瞻性匹配病例对照研究，对出院患者进行了为期六个月的随访，以评估新加坡医院耐甲氧西林金黄色葡萄球菌（MRSA）医院感染的直接临床和经济影响。新加坡两家三级公立医院的连续医院获得性 MRSA 感染病例，根据年龄、专科服务、主要手术（如有）和 Charlson 合并症指数，与每位患者最多两名非感染对照进行匹配。在住院期间和幸存者出院后六个月进行病历回顾和患者访谈。分析的结果是：死亡率、住院时间（LOS）、与医疗保健相关的财务成本和健康相关的生活质量。最后，通过出院时由访谈者管理的 EuroQol-5D 问卷进行评估，并转换为单一健康状态综合指数。通过条件逻辑回归和线性回归确定归因结果。共有 181 例病例和 351 例对照。MRSA 感染与院内死亡独立相关[14.4%比 1.4%；比值比（OR）：5.54；95%置信区间（CI）：1.63-18.79，P=0.006]、住院时间更长（中位数 32 天比 7 天；系数：1.21；95%CI：1.02-1.40，P<0.001）、住院费用更高（中位数 18129.89 美元比 4490.47 美元；系数：1.14；95%CI：0.93-1.35；P<0.001）、出院后与医疗保健相关的财务成本更高（中位数 337.24 美元比 259.29 美元；系数：0.39；95%CI：0.06-0.72；P=0.021）和较差的健康相关生活质量（系数：-0.14；95%CI：-0.21 至-0.08；P<0.001）。两家医院之间的结果没有显著差异。MRSA 感染对新加坡个人、机构和社会的可归因影响是相当大的。预防此类感染将显著改善患者的预后和医疗服务提供。
