APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018 Paris, France.
APHP, CHU Bichat-Claude Bernard, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, 46 rue Henri Huchard, 75018 Paris, France.
Anaesth Crit Care Pain Med. 2022 Aug;41(4):101093. doi: 10.1016/j.accpm.2022.101093. Epub 2022 Apr 30.
A 15-month outbreak of carbapenemase-producing Enterobacterales (CPE) occurred in the surgical intensive care unit (SICU) of our institution. We aimed to estimate the financial impact of this outbreak from the perspective of the French public health insurance system.
The characteristics of the colonised/infected CPE patients and outbreak management according to French national guidelines were prospectively collected. Loss of productivity was assessed in terms of the reduction in total number of admissions (TNA) and discharges and in ICU length of stay (LoS). The additional financial burden associated with this outbreak was estimated by the accounting department of the hospital, including the impact of the extended LoS and restricted admissions.
Sixteen CPE patients (19 stays) were hospitalised in the SICU (10/2016-01/2018). The median ICU LoS for the CPE cases was 17 [8-36] days versus 6.5 and 6.1 days in 2016 and 2017, respectively, for the whole SICU population. The total number of lost bed days during the outbreak was 452. The TNA dropped dramatically in 2017 (decrease of 20.6%). The estimated costs were 768,386 EUR for bed days lost; 297,176 EUR and 63,675 EUR for the extended LoS for the CPE cases and the patients on contact precautions, respectively; 34,045 EUR for staff reinforcements; 85,764 EUR for bacteriological screening tests; and 42,857 EUR for antimicrobial treatment. The total financial burden of the outbreak was 1,291,903 EUR.
Management of a CPE outbreak in the SICU is associated with a huge financial burden for the unit and for the institution.
本机构外科重症监护病房（SICU）发生了为期 15 个月的碳青霉烯酶肠杆菌科（CPE）爆发。我们旨在从法国公共卫生保险体系的角度评估此次爆发的经济影响。
前瞻性收集了定植/感染 CPE 患者的特征以及根据法国国家指南进行的爆发管理情况。通过减少总入院人数（TNA）和出院人数以及 ICU 住院时间（LoS）来评估生产力损失。医院会计部门估算了与此次爆发相关的额外财务负担，包括延长的 LoS 和受限的入院对其的影响。
16 例 CPE 患者（19 例住院）在 SICU 住院（2016 年 1 月至 2018 年 1 月）。CPE 病例的 ICU 中位 LOS 为 17 [8-36] 天，而 2016 年和 2017 年整个 SICU 人群的中位数分别为 6.5 和 6.1 天。爆发期间总失床日数为 452 天。2017 年 TNA 急剧下降（减少 20.6%）。估计损失的床位日数为 768,386 欧元；CPE 病例和接触预防措施患者的延长 LOS 分别为 297,176 欧元和 63,675 欧元；人员增援 34,045 欧元；细菌学筛查试验 85,764 欧元；抗菌治疗 42,857 欧元。此次爆发的总经济负担为 1,291,903 欧元。
SICU 中 CPE 爆发的管理给科室和机构带来了巨大的经济负担。
