Department of Econometrics and Business Statistics, Monash University, Clayton, VIC, Australia.
Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia.
Antimicrob Resist Infect Control. 2024 Jul 29;13(1):82. doi: 10.1186/s13756-024-01437-x.
Hospitals in any given region can be considered as part of a network, where facilities are connected to one another - and hospital pathogens potentially spread - through the movement of patients between them. We sought to describe the hospital admission patterns of patients known to be colonised with carbapenemase-producing Enterobacterales (CPE), and compare them with CPE-negative patient cohorts, matched on comorbidity information.
We performed a linkage study in Victoria, Australia, including datasets with notifiable diseases (CPE notifications) and hospital admissions (admission dates and diagnostic codes) for the period 2011 to 2020. Where the CPE notification date occurred during a hospital admission for the same patient, we identified this as the 'index admission'. We determined the number of distinct health services each patient was admitted to, and time to first admission to a different health service. We compared CPE-positive patients with four cohorts of CPE-negative patients, sampled based on different matching criteria.
Of 528 unique patients who had CPE detected during a hospital admission, 222 (42%) were subsequently admitted to a different health service during the study period. Among these patients, CPE diagnosis tended to occur during admission to a metropolitan public hospital (86%, 190/222), whereas there was a greater number of metropolitan private (23%, 52/222) and rural public (18%, 39/222) hospitals for the subsequent admission. Median time to next admission was 4 days (IQR, 0-75 days). Admission patterns for CPE-positive patients was similar to the cohort of CPE-negative patients matched on index admission, time period, and age-adjusted Charlson comorbidity index.
Movement of CPE-positive patients between health services is not a rare event. While the most common movement is from one public metropolitan health service to another, there is also a trend for movement from metropolitan public hospitals into private and rural hospitals. After accounting for clinical comorbidities, CPE colonisation status does not appear to impact on hospital admission frequency or timing. These findings support the potential utility of a centralised notification and outbreak management system for CPE positive patients.
在任何给定的地区，医院都可以被视为一个网络的一部分，在这个网络中，医疗机构之间通过患者的转移而相互连接——医院病原体也可能通过这种转移而传播。我们旨在描述已知定植有碳青霉烯酶产生肠杆菌科（CPE）的患者的住院模式，并将其与基于合并症信息匹配的 CPE 阴性患者队列进行比较。
我们在澳大利亚维多利亚州进行了一项基于病例的队列研究，该研究包含了 2011 年至 2020 年期间的传染病报告（CPE 报告）和医院入院数据（入院日期和诊断代码）。如果 CPE 报告日期与同一患者的住院期间重合，则将其确定为“索引入院”。我们确定了每位患者被不同医疗机构收治的次数，以及首次转入不同医疗机构的时间。我们将 CPE 阳性患者与基于不同匹配标准的四个 CPE 阴性患者队列进行了比较。
在 528 名在住院期间检测到 CPE 的患者中，222 名（42%）在研究期间随后转入了不同的医疗机构。在这些患者中，CPE 诊断往往发生在转入大都市公立医院期间（86%，190/222），而在转入大都市私立医院（23%，52/222）和农村公立医院（18%，39/222）的次数更多。下一次入院的中位时间为 4 天（IQR，0-75 天）。CPE 阳性患者的入院模式与基于索引入院、时间段和年龄调整 Charlson 合并症指数匹配的 CPE 阴性患者队列相似。
CPE 阳性患者在医疗机构之间的转移并非罕见事件。虽然最常见的转移是从一个大都市公共卫生服务机构到另一个机构，但也有从大都市公立医院向私立和农村医院转移的趋势。在考虑了临床合并症后，CPE 定植状态似乎不会影响住院频率或时间。这些发现支持为 CPE 阳性患者建立集中报告和暴发管理系统的潜在效用。
