Shoji Tomokazu, Muto Ryusei, Sakai Ryoko, Matsumura Hiroki, Uchida Takashi, Kitta Fumihiko, Inoue Osamu, Kawata Keishi, Akazawa Manabu
Department of Pharmacy, University of Yamanashi Hospital, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan.
Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo 204-8588, Japan.
AIMS Microbiol. 2022 Dec 19;8(4):528-543. doi: 10.3934/microbiol.2022034. eCollection 2022.
This retrospective, observational cohort study investigated the economic impact of genotype by classifying methicillin-resistant (MRSA) by using the polymerase chain reaction-based open reading frame typing (POT) method. Using administrative claims and bacteriological data for April 2016 to March 2021 from the University of Yamanashi Hospital, we ascertained the POT1 numbers and classified MRSA as either "hospital-derived" or "community-derived". We defined MRSA-associated medical practices and estimated the associated medical costs. After applying inverse probability of treatment weighting (IPTW)-based adjustment for patient characteristics between the two groups, we estimated the differences in medical costs during the "total therapy period" (defined as the interval from specimen submission to Day 42 after the susceptibility report) and the "definitive therapy period" (defined as the interval from susceptibility reporting to Day 42). Among the 135 MRSA-infected patients, 54 and 81 were classified as having hospital-derived and community-derived MRSA infections, respectively. Significant differences in patient characteristics were observed with regard to age ( = 0.0478), sex ( = 0.0422), surgery ( = 0.0349), chemotherapy ( = 0.0457) and immunosuppressive drug use ( = 0.0222). The median duration of the definitive therapy was 29 and 27 days, and the mortality rate during this period was 11% and 5% for the hospital-derived and community-derived types, respectively. After IPTW-based adjustment, the medical costs for the total therapy period were 324,480 and 296,462 Japanese yen (JPY) per patient for the hospital-derived and community-derived types, respectively, whereas the medical costs for the definitive therapy period were 279,635 and 256,542 JPY per patient for the hospital-derived and community-derived types, respectively. No statistically significant difference was detected ( = 0.5813 and = 0.6355, respectively). In this study, MRSA healthcare costs were compared according to the POT scores, and no statistically significant differences were observed between hospital-derived and community-derived MRSA infections.
这项回顾性观察队列研究通过使用基于聚合酶链反应的开放阅读框分型（POT）方法对耐甲氧西林金黄色葡萄球菌（MRSA）进行基因分型，调查了其经济影响。利用山梨大学医院2016年4月至2021年3月的行政索赔和细菌学数据，我们确定了POT1编号，并将MRSA分为“医院获得性”或“社区获得性”。我们定义了与MRSA相关的医疗行为，并估算了相关医疗费用。在对两组患者特征应用基于治疗权重逆概率（IPTW）的调整后，我们估算了“总治疗期”（定义为从标本送检至药敏报告后第42天的时间段）和“确定性治疗期”（定义为从药敏报告至第42天的时间段）的医疗费用差异。在135例MRSA感染患者中，分别有54例和81例被分类为医院获得性和社区获得性MRSA感染。在年龄（P = 0.0478）、性别（P = 0.0422）、手术（P = 0.0349）、化疗（P = 0.0457）和免疫抑制药物使用（P = 0.0222）方面观察到患者特征存在显著差异。确定性治疗的中位持续时间分别为29天和27天，在此期间医院获得性和社区获得性类型的死亡率分别为11%和5%。经过基于IPTW的调整后，总治疗期的医疗费用对于医院获得性和社区获得性类型分别为每位患者324,480日元和296,462日元，而确定性治疗期的医疗费用对于医院获得性和社区获得性类型分别为每位患者279,635日元和256,542日元。未检测到统计学显著差异（分别为P = 0.5813和P = 0.6355）。在本研究中，根据POT评分比较了MRSA的医疗费用，在医院获得性和社区获得性MRSA感染之间未观察到统计学显著差异。
