Bezerra I L, Nassar A P, Mendonça Dos Santos T, Tomazini B M, Veiga V C, Arns B, Nascimento G M, Cavalcanti A B, Malheiro D T, Pereira A J
Big Data, Program to Support the Institutional Development of the Unified Health System (PROADI-SUS), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Big Data, Program to Support the Institutional Development of the Unified Health System (PROADI-SUS), Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
J Hosp Infect. 2025 May;159:106-114. doi: 10.1016/j.jhin.2024.07.002. Epub 2024 Jul 18.
Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length of stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, and were performed in a small number of centres or only in high-income countries.
To assess the incremental cost of intensive care unit (ICU) HAIs in a large cohort of critically ill patients in a platform collaborative study.
A prospective cohort study was performed in ten Brazilian ICUs selected from a collaborative platform study (IMPACTO MR). All patients aged ≥18 years admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days were included. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. A propensity score matching method was used to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and multidrug-resistant (MDR) HAIs.
The study included 7953 patients, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs ($19,642 (IQR: 12,884-35,134) vs 6,086 (IQR: 3268-12,550); P < 0.001). Patients with VAP, CLABSI, and CAUTI, but not with MDR-HAIs, also had higher total ICU costs.
HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.
医院获得性感染（HAIs）与死亡率增加和住院时间延长有关。尽管一些研究表明HAIs与成本增加有关，但这些研究仅使用成本估算，且是在少数中心或仅在高收入国家进行的。
在一项平台合作研究中，评估一大群重症患者中重症监护病房（ICU）HAIs的增量成本。
在从合作平台研究（IMPACTO MR）中选取的巴西10个ICU中进行了一项前瞻性队列研究。纳入2019年10月至2021年12月入院、年龄≥18岁且ICU住院时间至少两天的所有患者。成本根据截至2022年12月的官方通货膨胀进行调整，并使用2021年购买力平价（PPP）换算率换算为国际美元。采用倾向得分匹配方法比较发生HAIs的患者与未发生HAIs的患者，以及发生和未发生呼吸机相关性肺炎（VAP）、中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和多重耐药（MDR）HAIs的患者。
该研究纳入了7953例患者，其中574例（7.2%）在ICU住院期间发生了HAIs。倾向得分匹配后，发生HAIs的患者的ICU成本比未发生HAIs的患者高出三倍多（19,642美元（四分位间距：12,884 - 35,134美元）对6,086美元（四分位间距：3268 - 12,550美元）；P < 0.001）。发生VAP、CLABSI和CAUTI的患者，但不包括发生MDR-HAIs的患者，其ICU总成本也更高。
在ICU获得的HAIs与更高的ICU成本相关。这些发现在特定类型的感染中是一致的。
