Riu Marta, Chiarello Pietro, Terradas Roser, Sala Maria, Garcia-Alzorriz Enric, Castells Xavier, Grau Santiago, Cots Francesc
Management Control Department, Hospital del Mar IMIM (Hospital del Mar Medical Research Institute) Doctoral Program in Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB) School of Nursing Department of Epidemiology and Evaluation, Hospital del Mar REDISSEC (Red de Investigación en Servicios Sanitarios en enfermedades crónicas) Universitat Autònoma de Barcelona (UAB) Department of Pharmacy, Hospital del Mar, Barcelona, Spain.
Medicine (Baltimore). 2017 Apr;96(17):e6645. doi: 10.1097/MD.0000000000006645.
To estimate the incremental cost of nosocomial bacteremia according to the causative focus and classified by the antibiotic sensitivity of the microorganism.Patients admitted to Hospital del Mar in Barcelona from 2005 to 2012 were included. We analyzed the total hospital costs of patients with nosocomial bacteremia caused by microorganisms with a high prevalence and, often, with multidrug-resistance. A control group was defined by selecting patients without bacteremia in the same diagnosis-related group.Our hospital has a cost accounting system (full-costing) that uses activity-based criteria to estimate per-patient costs. A logistic regression was fitted to estimate the probability of developing bacteremia (propensity score) and was used for propensity-score matching adjustment. This propensity score was included in an econometric model to adjust the incremental cost of patients with bacteremia with differentiation of the causative focus and antibiotic sensitivity.The mean incremental cost was estimated at &OV0556;15,526. The lowest incremental cost corresponded to bacteremia caused by multidrug-sensitive urinary infection (&OV0556;6786) and the highest to primary or unknown sources of bacteremia caused by multidrug-resistant microorganisms (&OV0556;29,186).This is one of the first analyses to include all episodes of bacteremia produced during hospital stays in a single study. The study included accurate information about the focus and antibiotic sensitivity of the causative organism and actual hospital costs. It provides information that could be useful to improve, establish, and prioritize prevention strategies for nosocomial infections.
根据感染源以及微生物的抗生素敏感性分类，估算医院获得性菌血症的增量成本。纳入了2005年至2012年在巴塞罗那德尔玛医院住院的患者。我们分析了由高流行率且通常具有多重耐药性的微生物引起的医院获得性菌血症患者的总住院费用。通过在同一诊断相关组中选择无菌血症的患者来定义对照组。我们医院有一个成本核算系统（完全成本核算），该系统使用基于活动的标准来估算每位患者的成本。拟合逻辑回归以估算发生菌血症的概率（倾向得分），并用于倾向得分匹配调整。该倾向得分被纳入一个计量经济学模型，以区分感染源和抗生素敏感性来调整菌血症患者的增量成本。平均增量成本估计为15526欧元。增量成本最低的是由对多种药物敏感的泌尿系统感染引起的菌血症（6786欧元），最高的是由多重耐药微生物引起的原发性或不明来源的菌血症（29186欧元）。这是首次在单一研究中纳入住院期间发生的所有菌血症病例的分析之一。该研究包含了有关病原体感染源和抗生素敏感性以及实际住院费用的准确信息。它提供了有助于改进、制定医院感染预防策略并确定其优先级的信息。
