Balderas-Peña Luz-Ma-Adriana, Sat-Muñoz Daniel, Ramírez-Conchas Rosa-Emilia, Alvarado-Iñiguez Moisés-Roberto, García-de-Alba-García Javier-Eduardo, Cruz-Corona Eduardo, Chávez-Hurtado José-Luis, Chagollán-Ramírez José-Martín
Unidad de Investigación Médica en Epidemiología Clínica (UIMEC) of Unidad Médica de Alta Especialidad Hospital de Especialidades Centro Médico Nacional de Occidente (UMAE HE CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México.
UMAE HE CMNO, IMSS and Departamento de Morfología, Centro Universitario de Ciencias de la Salud, UdG.
Ostomy Wound Manage. 2016 Dec;62(12):14-28.
Infection plays a critical role in health care and impacts the cost of the treatment of diabetic foot ulcers (DFU). To examine the cost reduction associated with the multidisciplinary treatment of infected DFU (IDFU) by obtaining early (ie, within 48 hours of admission) microbiological culture results, a descriptive, longitudinal study was conducted. Data were collected prospectively from patient medical charts of a cohort of 67 patients (mean age, 56.14 ± 12.3 years; mean duration of diabetes, 14.95 ± 8 years) with IDFU treated at a Mexican public health facility from January 1 to April 30, 2010. Information included demographic data (age, gender, marital status, time elapsed since first diagnosis of diabetes mellitus type 2 [DM2]), and the following clinical records: Wagner classification, bacterium type, antimicrobial resistance, length of hospital stay, and the antibiotic schedule utilized, as well as number and type of laboratory tests, medications, intravenous therapy, surgical and supportive treatment, type and number of specialists, and clinical outcome. Microcosting was used to calculate the unit cost of each medical treatment element. Using the Monte Carlo and Markov predictive simulation economical models, cost reduction associated with early identification of the specific microorganism through bacterial culture in IDFU was estimated. Based on the statistical results, differences between real and estimated costs when including early microbiological culture were identified and the number and type of most common species of infectious bacteria were detected. The total cost observed in the patient cohort was $502 438.04 USD, mean cost per patient was $7177.69 ± $5043.51 USD, and 72.75% of the total cost was associated with the hospital stay length. The cost of the entire treatment including antibiotics was $359 196.16 USD; based on the simulation of early microbiological culture, the model results showed cost could be reduced by 10% to 25% (in this study, the cost could be as low as $304 624.63 USD). The use of early microbiological cultures on IDFU to determine the appropriate antibiotic can reduce treatment costs by >30% if hospital stay is part of the consideration.
感染在医疗保健中起着关键作用，并影响糖尿病足溃疡（DFU）的治疗成本。为了通过获取早期（即入院后48小时内）微生物培养结果来研究与感染性DFU（IDFU）多学科治疗相关的成本降低情况，开展了一项描述性纵向研究。前瞻性收集了2010年1月1日至4月30日在墨西哥一家公共卫生机构接受治疗的67例IDFU患者（平均年龄56.14±12.3岁；平均糖尿病病程14.95±8年）的病历数据。信息包括人口统计学数据（年龄、性别、婚姻状况、自首次诊断2型糖尿病[DM2]以来的时间），以及以下临床记录：瓦格纳分级、细菌类型、抗菌药物耐药性、住院时间、使用的抗生素方案，以及实验室检查的数量和类型、药物、静脉治疗、手术和支持治疗、专科医生的类型和数量，以及临床结局。采用微观成本核算来计算每个医疗治疗要素的单位成本。使用蒙特卡洛和马尔可夫预测模拟经济模型，估计通过IDFU细菌培养早期鉴定特定微生物相关的成本降低情况。根据统计结果，确定了纳入早期微生物培养时实际成本与估计成本之间的差异，并检测了最常见感染细菌种类的数量和类型。患者队列中观察到的总成本为502438.04美元，每位患者的平均成本为7177.69±5043.51美元，总成本的72.75%与住院时间相关。包括抗生素在内的整个治疗成本为359196.16美元；基于早期微生物培养的模拟，模型结果显示成本可降低10%至25%（在本研究中，成本可低至304624.63美元）。如果将住院时间作为考虑因素，对IDFU使用早期微生物培养来确定合适的抗生素可使治疗成本降低>30%。
