Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Clin Microbiol Infect. 2023 Mar;29(3):346-352. doi: 10.1016/j.cmi.2022.09.004. Epub 2022 Sep 20.
Population-based estimates of excess length of stay after hospital-acquired bacteraemia (HAB) are few and prone to time-dependent bias. We investigated the excess length of stay and readmission after HAB.
This population-based cohort study included the North Denmark Region adult population hospitalized for ≥48 hours, from 2006 to 2018. Using a multi-state model with 45 days of follow-up, we estimated adjusted hazard ratios (aHRs) for end of stay and discharge alive. The excess length of stay was defined as the difference in residual length of stay between infected and uninfected patients, estimated using a non-parametric approach with HAB as time-dependent exposure. Confounder effects were estimated using pseudo-value regression. Readmission after HAB was investigated using the Cox regression.
We identified 3457 episodes of HAB in 484 291 admissions in 205 962 unique patients. Following HAB, excess length of stay was 6.6 days (95% CI, 6.2-7.1 days) compared with patients at risk. HAB was associated with decreased probability of end of hospital stay (aHR, 0.60; 95% CI, 0.57-0.62) driven by the decreased hazard for discharge alive; the aHRs ranged from 0.30 (95% CI, 0.23-0.40) for bacteraemia stemming from 'heart and vascular' source to 0.72 (95% CI, 0.69-0.82) for the 'urinary tract'. Despite increased post-discharge mortality (aHR, 2.76; 95% CI, 2.38-3.21), HAB was associated with readmission (aHR, 1.42; 95% CI, 1.31-1.53).
HAB was associated with considerably excess length of hospital stay compared with hospitalized patients without bacteraemia. Among patients discharged alive, HAB was associated with increased readmission rates.
关于医院获得性菌血症（HAB）后住院时间延长的人群估计数据很少，且容易受到时间依赖性偏倚的影响。本研究旨在调查 HAB 后住院时间延长和再入院的情况。
本研究为基于人群的队列研究，纳入了 2006 年至 2018 年期间在丹麦北地区住院时间≥48 小时的成年患者。通过使用 45 天随访的多状态模型，我们估计了终点时和存活出院的调整后风险比（aHR）。感染和未感染患者之间的剩余住院时间差异被定义为感染患者的住院时间延长，使用非参数方法估计，并将 HAB 作为时间依赖性暴露因素。使用伪值回归估计混杂因素的影响。使用 Cox 回归分析 HAB 后的再入院情况。
在 205962 名患者的 484291 次住院中，我们共发现了 3457 例 HAB 发作。与有风险的患者相比，HAB 后住院时间延长了 6.6 天（95%CI，6.2-7.1 天）。HAB 与存活出院的可能性降低相关（aHR，0.60；95%CI，0.57-0.62），这主要是由于出院的风险降低；aHR 范围从源自“心脏和血管”来源的菌血症的 0.30（95%CI，0.23-0.40）到“泌尿道”的 0.72（95%CI，0.69-0.82）。尽管出院后的死亡率增加（aHR，2.76；95%CI，2.38-3.21），但 HAB 与再入院相关（aHR，1.42；95%CI，1.31-1.53）。
与未发生菌血症的住院患者相比，HAB 后住院时间明显延长。在存活出院的患者中，HAB 与再入院率增加相关。
