Adler Alexandra C, Zamfir Mihai, Hendrowarsito Lana, Dammeyer Antchen, Schomacher Lasse, Karlin Barbara, Franitza Manuela, Nasri Lilia, Hörmansdorfer Stefan, Tuschak Christian, Valenza Giuseppe, Ewert Thomas, Hierl Wolfgang, Ochmann Uta, Herr Caroline, Heinze Stefanie
Bavarian Health and Food Safety Authority, Erlangen, Germany.
Bavarian Health and Food Safety Authority, Erlangen, Germany.
Eur J Obstet Gynecol Reprod Biol. 2017 Aug;215:20-27. doi: 10.1016/j.ejogrb.2017.05.022. Epub 2017 May 30.
Antimicrobial resistant bacteria (AMR) are of public health and economic relevance. However, there is a lack of data regarding AMR colonization in pregnant women and in newborns. Furthermore, there are few studies analyzing hospital's net income (revenues and costs).
The cross-sectional study took place in two Bavarian clinics. Available data regarding women and newborns were collected using a standardized questionnaire, personal IDs and medical records in addition to AMR/MSSA screening. Economic data consisted of estimated hospitalization costs, calculated using a billing system called G-DRG (German-Diagnosis Related Groups) as well as real hospitalization costs (e.g. staff, medical and non-medical infrastructure costs).
Data from 635 pregnant women and 566 newborns were included. While AMR colonization has shown no significant association with clinical complications, or net hospital income; primipara status and medical condition during pregnancy did. AMR colonization did not have a significant influence on the health status of pregnant women or of the newborns. Net hospital income for pregnant women was mostly negative in 2014. In 2014 and 2015 the majority of the cases had a net income between ±€ 1000. Newborns with clinical complications differed significantly in Apgar score at 1min, weight, body length and AMR colonization of the pregnant woman and/or the newborn (p<=0.05).
Results indicate that colonization does not lead to increased costs during hospitalization considering real hospitalization costs as well as G-DRG estimated costs. Both DRG groups had similar MSSA and AMR prevalence and health status. In future studies, a Centralized Cost Accounting as billing method and an improved possibility of AMR coding in G-DRG catalog would be desirable.
抗菌药物耐药菌（AMR）具有公共卫生和经济意义。然而，关于孕妇和新生儿中AMR定植的数据匮乏。此外，分析医院净收入（收入和成本）的研究很少。
这项横断面研究在巴伐利亚的两家诊所进行。除了AMR/MSSA筛查外，还使用标准化问卷、个人身份证和病历收集了有关妇女和新生儿的可用数据。经济数据包括使用名为G-DRG（德国诊断相关组）的计费系统计算的估计住院费用以及实际住院费用（如工作人员、医疗和非医疗基础设施成本）。
纳入了635名孕妇和566名新生儿的数据。虽然AMR定植与临床并发症或医院净收入无显著关联；但初产妇状态和孕期医疗状况有显著关联。AMR定植对孕妇或新生儿的健康状况没有显著影响。2014年孕妇的医院净收入大多为负。2014年和2015年，大多数病例的净收入在±1000欧元之间。有临床并发症的新生儿在1分钟时的阿氏评分、体重、身长以及孕妇和/或新生儿的AMR定植方面存在显著差异（p<=0.05）。
结果表明，考虑到实际住院费用以及G-DRG估计费用，定植不会导致住院期间成本增加。两个DRG组的MSSA和AMR患病率以及健康状况相似。在未来的研究中，采用集中成本核算作为计费方法以及改进G-DRG目录中AMR编码的可能性将是可取的。
