Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.
Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France; Assistance Publique/Hôpitaux de Paris, Raymond-Poincaré Hospital, 104 Boulevard Raymond Poincaré, Garches, France.
J Infect. 2021 Mar;82(3):339-345. doi: 10.1016/j.jinf.2021.02.001. Epub 2021 Feb 5.
The impact of antibiotic resistance (AMR) on initial hospital management has been extensively studied but its consequences after hospital discharge remain largely unknown. We aimed to analyze hospital care trajectories, cumulative length of hospital stays (c-LOS) and associated costs of care over a 1-year period after hospitalization with incident AMR infection.
All incident bacterial infection-related hospitalizations occurring from January 1, 2015, to December 31, 2015 and recorded in the French national health data information system were extracted. Bacterial resistance ICD-10 codes determined six infection status. Inpatient and outpatient care consumption and associated costs were studied. The impact of resistance on c-LOS was estimated using a Poisson regression. A sequence analysis through optimal matching method was conducted to identify hospital trajectories along with an extrapolation.
Of the 73,244 patients selected, 15.9% had AMR infection, thus providing 58,286 incident AMR infections after extrapolation. c-LOS was significantly longer for infections with resistant bacteria, reaching 20.4 days and 2.9 additional days IC95%[2.6; 3.2] for skin and soft tissue infections. An estimated 29,793 (51.1%) patients had hospital readmission within the following year, for a total cost of €675 million. Five post-discharge trajectories were identified: Post-hospitalization mainly at home (68.4% of patients); Transition to home from rehabilitation care (12.3%); Early death (<3 months) (9.7%); Late death (7.4%), and Long-term hospitalization (2.2%).
AMR has an impact on patients' c-LOS stay beyond the initial hospitalization. Half of patients hospitalized due to AMR are readmitted to hospital within the ensuing year, along five different trajectories.
French Ministry of health.
抗生素耐药性（AMR）对初始医院管理的影响已得到广泛研究，但出院后的后果在很大程度上仍不清楚。我们旨在分析住院后 1 年内与 AMR 感染相关的医院护理轨迹、累计住院时间（c-LOS）和相关护理费用。
从 2015 年 1 月 1 日至 12 月 31 日，从法国国家健康数据信息系统中提取所有与细菌感染相关的住院事件，并记录在案。细菌耐药性 ICD-10 代码确定了六种感染状态。研究了住院和门诊护理的消耗和相关费用。使用泊松回归估计耐药性对 c-LOS 的影响。通过最优匹配方法进行序列分析，以确定医院轨迹和外推。
在 73244 名选定患者中，15.9%患有 AMR 感染，因此在进行外推后，共有 58286 例 AMR 感染的新发感染。感染耐药菌的患者的 c-LOS 明显更长，皮肤和软组织感染的住院时间为 20.4 天，增加了 2.9 天（95%CI[2.6；3.2]）。估计在接下来的一年中，有 29793 名（51.1%）患者再次住院，总费用为 6.75 亿欧元。确定了五种出院后轨迹：主要在医院后在家（68.4%的患者）；从康复护理过渡到家庭（12.3%）；<3 个月内早期死亡（9.7%）；晚期死亡（7.4%）和长期住院（2.2%）。
AMR 对初始住院后患者的 c-LOS 住院时间有影响。由于 AMR 住院的患者中有一半在接下来的一年中再次住院，有五条不同的轨迹。
法国卫生部。
