Lee Hojin, Lee Hyuck
Division of Infectious Diseases, Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.
Infect Chemother. 2016 Sep;48(3):174-180. doi: 10.3947/ic.2016.48.3.174. Epub 2016 Sep 19.
The clinical and economic impact of multidrug-resistant (MDR) Acinetobacter baumannii colonization remains unclear. This study aimed to estimate and compare the mortality rates, length of stay (LOS), and hospitalization costs in the intensive care unit (ICU) for MDR A. baumannii colonized patients and a matched population.
We performed a retrospective propensity score matched cohort study comparing the outcomes of patients with MDR A. baumannii colonization with those of uncolonized subjects matched at the time they were admitted to the ICU between January 2012 and December 2014.
During the study period, 375 (7.5%) of the 4,779 patients were colonized with MDR A. baumannii. One hundred and twenty-two MDR A. baumannii colonized patients were compared with 122 uncolonized patients using propensity score matching. MDR A. baumannii colonized patients were likely to have a higher mortality rate compared to uncolonized patients (49.2% vs 32.0%; odds ratio [OR], 3.64). A longer ICU LOS and total admission days were observed in the MDR A. baumannii colonized patient group (4.14 and 4.67 days increase, OR 1.41 and 1.19). MDR A. baumannii colonization patients had an average extra ICU and total admission cost of $1,179 (₩1,261,334) and $1,333 (₩1,422,032) according to a multivariable regression model (OR, 1.27 and 1.17). Multivariable analysis identified the factors affecting ICU cost, which included, MDR A. baumannii colonization (OR = 1.33; P = 0.001), ICU LOS (OR = 1.97; P <0.001), valvular heart disease (OR = 1.12; P = 0.005), invasive devices (OR = 1.15; P = 0.018), and surgery (OR = 1.1; P < 0.001).
MDR A. baumannii colonization was associated with increased mortality, LOS, and costs in the ICU. A strict infection control program including preemptive isolation for high-risk groups would be helpful for reducing the burden of this infection.
多重耐药鲍曼不动杆菌定植的临床和经济影响尚不清楚。本研究旨在评估和比较多重耐药鲍曼不动杆菌定植患者与匹配人群在重症监护病房（ICU）的死亡率、住院时间（LOS）和住院费用。
我们进行了一项回顾性倾向评分匹配队列研究，比较了2012年1月至2014年12月期间入住ICU时多重耐药鲍曼不动杆菌定植患者与未定植患者的结局。
在研究期间，4779例患者中有375例（7.5%）定植了多重耐药鲍曼不动杆菌。使用倾向评分匹配将122例多重耐药鲍曼不动杆菌定植患者与122例未定植患者进行比较。与未定植患者相比，多重耐药鲍曼不动杆菌定植患者的死亡率可能更高（49.2%对32.0%；比值比[OR]，3.64）。在多重耐药鲍曼不动杆菌定植患者组中观察到更长的ICU住院时间和总住院天数（分别增加4.14天和4.67天，OR分别为1.41和1.19）。根据多变量回归模型，多重耐药鲍曼不动杆菌定植患者的ICU平均额外费用和总住院费用分别为1179美元（1261334韩元）和1333美元（1422032韩元）（OR分别为1.27和1.17）。多变量分析确定了影响ICU费用的因素，包括多重耐药鲍曼不动杆菌定植（OR = 1.33；P = 0.001）、ICU住院时间（OR = 1.97；P <0.001）、心脏瓣膜病（OR = 1.12；P = 0.005）、侵入性器械（OR = 1.15；P = 0.018）和手术（OR = 1.1；P <0.001）。
多重耐药鲍曼不动杆菌定植与ICU死亡率增加、住院时间延长和费用增加相关。包括对高危人群进行预防性隔离在内的严格感染控制计划有助于减轻这种感染的负担。
