复杂性尿路感染导致的住院患者费用：在多重耐药革兰氏阴性菌高流行国家进行的一项回顾性观察研究：COMBACTE-MAGNET拯救研究
Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study.
作者信息
Vallejo-Torres Laura, Pujol Miquel, Shaw Evelyn, Wiegand Irith, Vigo Joan Miquel, Stoddart Margaret, Grier Sally, Gibbs Julie, Vank Christiane, Cuperus Nienke, van den Heuvel Leo, Eliakim-Raz Noa, Carratala Jordi, Vuong Cuong, MacGowan Alasdair, Babich Tanya, Leibovici Leonard, Addy Ibironke, Morris Stephen
机构信息
UCL Department of Applied Health Research, University College London, London, UK.
Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
出版信息
BMJ Open. 2018 Apr 12;8(4):e020251. doi: 10.1136/bmjopen-2017-020251.
OBJECTIVE
Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR).
DESIGN
This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs.
SETTING
The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey).
PARTICIPANTS
Data were obtained from 644 episodes of patients hospitalised due to cUTI.
RESULTS
The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR.
CONCLUSIONS
The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.
目的
复杂性尿路感染（cUTIs）给医疗系统带来沉重负担，且是住院的常见原因。本文旨在估算因cUTI住院患者的单次发作成本，并探讨在多药耐药（MDR）高发的八个国家中与cUTI相关医疗成本有关的因素。
设计
这是一项跨国观察性回顾研究。通过将每位患者的医疗服务使用量乘以每项护理的单位成本，并对所有组成部分求和来计算单次发作的平均成本。成本从医院角度进行衡量。采用患者层面的回归分析来确定解释cUTI相关成本差异的因素。
背景
该研究在八个耐多药革兰氏阴性菌高发国家（保加利亚、希腊、匈牙利、以色列、意大利、罗马尼亚、西班牙和土耳其）的20家医院进行。
参与者
数据来自644例因cUTI住院的患者发作情况。
结果
每例平均成本为5700欧元，各国之间存在显著差异（土耳其最高值为7740欧元；以色列最低值为4028欧元），主要是由于住院时间不同。与每位患者成本较高相关的因素有：入院类型、感染源、感染严重程度、查尔森合并症指数和MDR的存在。
结论
cUTI住院病例的平均成本很高，且各国之间差异显著。更好地了解住院时间差异的原因有助于为cUTI患者提供更好的标准化护理质量，并实现医疗资源更有效的分配。急诊入院、因留置导尿管导致的感染、导致感染性休克或严重脓毒症、患有合并症且存在MDR的患者与较高成本相关。
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