碳青霉烯类耐药菌感染的经济和临床负担及相关因素：日本电子病历回顾性研究。
Economic and clinical burden from carbapenem-resistant bacterial infections and factors contributing: a retrospective study using electronic medical records in Japan.
机构信息
Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, 2-5-21, Higashigaoka, Meguroku, Tokyo, 152-8621, Japan.
Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1, Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
出版信息
BMC Infect Dis. 2022 Jun 29;22(1):581. doi: 10.1186/s12879-022-07548-3.
BACKGROUND
Antimicrobial resistance is a major threat to global health and the world economy. The economic burden of carbapenem-resistant infections has not previously been evaluated. We aimed to compare the potential economic burden and clinical outcomes between carbapenem-resistant infections and carbapenem-susceptible infections in Japan.
METHODS
We conducted a retrospective cohort study using electronic medical records. Patients aged 15 years or older and with the diagnosis of pneumonia, urinary tract infection, biliary infection, and sepsis were included. Multivariable regression models with random effects were used to estimate the impact of carbapenem resistance on cost, length of hospital stay, and in-hospital mortality.
RESULTS
Among the 9,517 patients, 86 (0.9%) had carbapenem-resistant (CR) infections. Compared to carbapenem-susceptible (CS) infections, the patients with the CR infections were significantly more likely to receive mechanical ventilation (37.2 vs. 21.2%, P-value = 0.003), antibiotics (88.4 vs. 63.0%, P-value < 0.001), and especially carbapenem (31.4 vs. 8.3%, P-value < 0.001), before the bacterial culture test positive. Significantly higher median costs were found for the CR infections than the CS infections in the categories of medications (3477 US dollars vs. 1609 US dollars), laboratory tests (2498 US dollars, vs. 1845 US dollars), and hospital stay (14,307 US dollars vs. 10,560 US dollars). In the multivariable regression analysis, the length of stay was 42.1% longer and the cost was 50.4% higher in the CR infections than in the CS infections. The risk of in-hospital mortality did not differ between the two groups (odds ratio 1.24, 95% CI 0.72-2.11), due to the small sample size. The result was robust with a similar trend in the analysis using the inverse probability treatment weighting method.
CONCLUSIONS
Compared to carbapenem-susceptible infections, carbapenem-resistant infections were associated with a higher cost and a longer length of stay. Detailed cost analysis showed significant differences in the categories of medication, laboratory tests, and hospital stay. To our knowledge, this study is the first to assess the potential economic burden of carbapenem-resistant infections using a large hospital-based database.
背景
抗菌药物耐药性是对全球健康和世界经济的重大威胁。此前尚未评估耐碳青霉烯类感染的经济负担。本研究旨在比较日本耐碳青霉烯类感染和碳青霉烯类敏感感染的潜在经济负担和临床结局。
方法
我们使用电子病历进行了回顾性队列研究。纳入年龄在 15 岁及以上、诊断为肺炎、尿路感染、胆道感染和败血症的患者。采用具有随机效应的多变量回归模型来估计碳青霉烯类耐药对成本、住院时间和院内死亡率的影响。
结果
在 9517 例患者中，86 例（0.9%）为耐碳青霉烯类（CR）感染。与碳青霉烯类敏感（CS）感染相比，CR 感染患者更有可能接受机械通气（37.2%比 21.2%，P 值=0.003）、使用更多种抗生素（88.4%比 63.0%，P 值<0.001），特别是碳青霉烯类药物（31.4%比 8.3%，P 值<0.001），这发生在细菌培养阳性之前。CR 感染患者的药物（3477 美元比 1609 美元）、实验室检查（2498 美元比 1845 美元）和住院时间（14307 美元比 10560 美元）的中位数费用明显高于 CS 感染患者。多变量回归分析显示，CR 感染患者的住院时间比 CS 感染患者长 42.1%，费用高 50.4%。由于样本量小，两组间院内死亡率无差异（比值比 1.24，95%CI 0.72-2.11）。使用逆概率处理加权法进行分析的结果具有相似趋势，结果稳健。
结论
与碳青霉烯类敏感感染相比，耐碳青霉烯类感染与更高的成本和更长的住院时间相关。详细的成本分析显示，在药物、实验室检查和住院时间方面存在显著差异。据我们所知，本研究首次使用大型基于医院的数据库评估耐碳青霉烯类感染的潜在经济负担。
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