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感染控制措施对医院相关成本和广谱抗菌药物使用量的影响:时间序列分析。

Impact of infection control measures on the related costs and the amount of broad-spectrum antimicrobial agents used in a hospital: A time-series analysis.

机构信息

Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.

Department of Pharmacy, Nishimino Kosei Hospital, Gifu, Japan.

出版信息

Int J Health Plann Manage. 2020 Jan;35(1):e133-e141. doi: 10.1002/hpm.2944. Epub 2019 Nov 6.

Abstract

Health care-associated infections (HAIs) worsen patient prognoses and increase medical costs. Antimicrobial stewardship (AMS), which involves appropriate use of antimicrobial agents and antiseptics, may be beneficial for addressing the issue of HAIs. In hospitals, an infection control team (ICT) plays an important role on the appropriate use of antimicrobial agents and antiseptics based on AMS. We aimed to conduct a time-series analysis of the efficacies of infection control measures in terms of related costs, amount of broad-spectrum antimicrobial agents used (carbapenems and quinolones), and methicillin-resistant Staphylococcus aureus (MRSA) detection rates. This retrospective cross-sectional study included in-hospital patients treated at a single institute between January 2012 and December 2015. The intervention start point (initiation of infection control measures) was January 2014. All survey items were subjected to segmented regression analysis using an autoregressive integrated moving average (ARIMA) model. Differences between pre-intervention and postintervention levels and their trends were assessed, using a statistical significance cutoff of P < .05. The infection control costs demonstrated a significantly increasing trend, despite significant decreases in the amount of carbapenems used. Accordingly, the implementation of infection control measures was associated with increased costs, whereas carbapenem use decreased immediately after intervention. Postintervention levels, trends of quinolone use, or MRSA detection rates did not reveal significant changes. Although implementation of infection control measures induced gradual increases in related costs, these measures led to immediate reductions in carbapenem use. Our study findings will support the establishment of more effective and economical infection control measures.

摘要

医疗保健相关性感染(HAI)会恶化患者预后并增加医疗成本。抗菌药物管理(AMS)涉及抗菌药物和防腐剂的合理使用,可能有助于解决 HAI 问题。在医院,感染控制团队(ICT)根据 AMS 在抗菌药物和防腐剂的合理使用方面发挥着重要作用。我们旨在进行时间序列分析,评估感染控制措施在相关成本、广谱抗菌药物使用量(碳青霉烯类和喹诺酮类)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率方面的效果。这项回顾性横断面研究包括 2012 年 1 月至 2015 年 12 月期间在一家机构住院治疗的患者。干预起点(感染控制措施的开始)为 2014 年 1 月。使用自回归综合移动平均(ARIMA)模型对所有调查项目进行分段回归分析。使用统计学意义截断值 P <.05 评估干预前后水平及其趋势的差异。尽管碳青霉烯类药物的使用量显著减少,但感染控制成本呈明显上升趋势。因此,尽管感染控制措施的实施会增加成本,但碳青霉烯类药物的使用在干预后立即减少。干预后水平、喹诺酮类药物使用趋势或 MRSA 检出率没有显示出显著变化。尽管实施感染控制措施会导致相关成本逐渐增加,但这些措施会立即减少碳青霉烯类药物的使用。我们的研究结果将支持建立更有效和经济的感染控制措施。

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