医疗保健相关性感染的临床和经济负担：一项前瞻性队列研究。
Clinical and economic burden of healthcare-associated infections: A prospective cohort study.
机构信息
Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Pharmacoepidemiology and Social Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
出版信息
PLoS One. 2023 Feb 23;18(2):e0282141. doi: 10.1371/journal.pone.0282141. eCollection 2023.
INTRODUCTION
Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs.
OBJECTIVE
To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital.
MATERIALS AND METHODS
A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses.
RESULTS
A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality.
CONCLUSION
HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.
简介
医疗保健相关感染（HAI）已成为严重的公共卫生问题。尽管实施基于证据的感染控制策略可以预防 HAI 并节省数十亿美元，但埃塞俄比亚缺乏关于 HAI 发生率、经济和临床负担的国家监测研究。
目的
评估 Ayder 综合专科医院住院患者 HAI 的临床和经济负担。
材料和方法
对有和没有 HAI 的患者进行前瞻性队列研究设计。通过审查病历、访谈和患者账单来提取必要信息。根据年龄、性别、Charlson 合并症指数和病房类型对两组患者进行匹配。使用配对 t 检验或 McNemar 检验比较感染和未感染患者的可衡量因素，视情况而定。使用逻辑回归识别住院死亡率的预测因素。使用 Stata 14.1 进行所有分析。
结果
共有 408 名患者，其中 204 名患有 HAI，204 名没有 HAI 被纳入研究。HAI 患者的院内死亡率更高（14.7%对 7.8%，P=0.028）。HAI 患者的平均住院时间比对照组长 8.3 天（18.85 对 10.59，P<0.001）。HAI 患者的平均直接医疗费用比对照组高 3033 埃塞俄比亚比尔（ETB）（4826 对 1793，P<0.001）。HAI 的存在（AOR：2.22，95%CI：1.13-4.39）和入住重症监护病房（AOR：3.39，95%CI：1.55-7.40）是住院死亡率的显著预测因素。
结论
HAI 对住院死亡率、额外住院时间和医疗费用有重大影响。入住重症监护病房的患者和患有 HAI 的患者被发现是住院死亡率的显著预测因素。必须实施干预措施以预防 HAI，尤其是在入住重症监护病房的患者中。
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