Department of Resource Economics and Environmental Sociology, University of Alberta, Edmonton, Canada.
J Hosp Infect. 2013 Sep;85(1):54-9. doi: 10.1016/j.jhin.2013.06.016. Epub 2013 Aug 6.
Competing resource demands have resulted in the de-escalation of vancomycin-resistant enterococcus (VRE) control programmes in some Canadian healthcare centres.
To determine the attributable costs and length of stay (LOS) of VRE colonizations/infections in an acute care hospital in Canada.
Surveillance and financial hospital-based databases were used to conduct analyses with cases and controls from fiscal year 2008-2009 (1 April 2008 to 31 March 2009) at an acute care hospital in downtown Vancouver, Canada. A statistical analysis of attributable costs and LOS was conducted using a generalized linear model. In a secondary analysis, differences in costs and LOS were examined for VRE infections versus colonizations.
A total of 217 patients with VRE and a random sample of 1075 patients without VRE were examined. VRE has a positive and significant impact on patient hospitalization costs and LOS. Overall, the presence of VRE increased the estimated mean cost per patient by 61.9% (95% confidence interval: 42.3-84.3) in relative terms and $17,949 (13,949-21,464) in absolute Canadian dollars. For LOS, the attributable number of days associated with a VRE case mean was 68.0% (41.9-98.9) higher in relative terms and 13.8 days (10.0-16.9) in absolute days. In the secondary analysis comparing VRE infection and colonization costs, no statistically significant difference was found.
Based on this analysis, the attributable cost and LOS of VRE are considerable. These factors should be considered before de-escalation of a hospital VRE control programme.
在一些加拿大医疗机构，由于资源需求相互竞争，肠球菌耐药（VRE）控制项目已有所降级。
旨在确定加拿大一家急性护理医院中 VRE 定植/感染的可归因成本和住院时间（LOS）。
利用监测和基于医院的财务数据库，对加拿大温哥华市中心一家急性护理医院 2008-2009 财年（2008 年 4 月 1 日至 2009 年 3 月 31 日）的病例和对照进行分析。采用广义线性模型对可归因成本和 LOS 进行统计分析。在二次分析中，对 VRE 感染与定植的成本和 LOS 差异进行了检验。
共检查了 217 例 VRE 患者和 1075 例随机无 VRE 患者。VRE 对患者住院费用和 LOS 有积极且显著的影响。总体而言，VRE 的存在使每位患者的估计平均住院费用增加了 61.9%（95%置信区间：42.3-84.3），绝对金额增加了 17949 加元（13949-21464）。在 LOS 方面，VRE 病例的归因天数相对增加了 68.0%（41.9-98.9），绝对天数增加了 13.8 天（10.0-16.9）。在比较 VRE 感染和定植成本的二次分析中，未发现统计学上的显著差异。
基于此分析，VRE 的可归因成本和 LOS 相当可观。在降低医院 VRE 控制项目级别之前，应考虑这些因素。
