Moradi Samaneh, Najafpour Zhila, Cheraghian Bahman, Keliddar Iman, Mombeyni Razieh
Department of Health Care Management, School of Public Health Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran.
Department of Biostatistics and Epidemiology, School of Public Health Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran.
Health Sci Rep. 2024 Nov 6;7(11):e70168. doi: 10.1002/hsr2.70168. eCollection 2024 Nov.
This study aims to compare the mortality rate, length of stay (LOS), and hospitalization cost in patients with and without healthcare-associated infections (HCAIs).
This prospective cohort study is conducted on 396 matched patients admitted to a tertiary teaching hospital with 800 beds in the southwest of Iran from July 2021 to January 2022. The cases were patients admitted during the study period who had, at minimum, one type of HCAI. For a comparison group, we considered all patients without HCAIs who hospitalized in the same ward and at the same time with the same age and gender in a ratio of one case to three controls. Descriptive analyses were done based on direct medical costs, LOS, and mortality rate in patients. The magnitude of the relationship between potential risk factors and HCAI was quantified using logistic regression.
The most common HCAI and microorganisms were urinary tract infection (UTI) and , respectively. The mean LOS for infected patients was 20.3 (±16) days, compared to 8.7 (±8.6) days for noninfected patients ( value ≤ 0.05). Lengths of stay (odds ratio [OR] = 1.09; 95% CI = 1.06-1.19; value = 0.000), ICU lengths of stay (OR = 1.08; 95% CI = 1.02-1.15; value = 0.003), presence of central Catheter (OR = 0.127; 95% CI = 0.51-0.319; value = 0.000), and urinary catheter (OR = 0.225; 95% CI = 0.122-0.415; value = 0.000), mechanical ventilation (OR = 0.136; 95% CI = 0.57-0.325; value = 0.000), receipt of immunosuppressors (OR = 1.99; 95% CI = 11.12-3.56; value = 0.01), were Significantly associated with HCAI. Patients with infections had a more costly hospital stay than noninfected patients (mean diff: $2037.46 ([SD]: 482.25$) ( value = 0.000). The highest cost component was the cost of medication expenditure (mean: $1612.66 ([SD]: $2542.27).
UTI was the most common HCAI in our study. An infection acquired during a hospital stay may be associated with higher hospitalization costs, prolonged hospitalization, and an increase in the rate of mortality. Longer lengths of stay, presence of central and urinary Catheters, receipt of immunosuppressors, use of mechanical ventilator were common risk factors for HCAI. This study reveals that the median reimbursement cost per hospitalization of patients with HCAIs was higher than patients without HCAIs. This highlights the necessity for implementation of HCAI prevention and control measures.
本研究旨在比较有和没有医疗保健相关感染（HCAIs）患者的死亡率、住院时间（LOS）和住院费用。
这项前瞻性队列研究对2021年7月至2022年1月期间入住伊朗西南部一家拥有800张床位的三级教学医院的396例匹配患者进行。病例为研究期间入院且至少有一种HCAI类型的患者。对于对照组，我们考虑了所有在同一病房、同一时间住院、年龄和性别相同且病例与对照比例为1:3的无HCAIs患者。基于患者的直接医疗费用、LOS和死亡率进行描述性分析。使用逻辑回归对潜在风险因素与HCAI之间的关系强度进行量化。
最常见的HCAI和微生物分别是尿路感染（UTI）和……。感染患者的平均住院时间为20.3（±16）天，未感染患者为8.7（±8.6）天（ 值≤0.05）。住院时间（比值比[OR]=1.09；95%置信区间=1.06 - 1.19； 值=0.000）、重症监护病房住院时间（OR = 1.08；95%置信区间=1.02 - 1.15； 值=0.003）、中心静脉导管的存在（OR = 0.127；95%置信区间=0.51 - 0.319； 值=0.000）、导尿管（OR = 0.225；95%置信区间=0.122 - 0.415； 值=0.000）、机械通气（OR = 0.136；95%置信区间=0.57 - 0.325； 值=0.000）、接受免疫抑制剂治疗（OR = 1.99；95%置信区间=11.12 - 3.56； 值=0.01）与HCAI显著相关。感染患者的住院费用高于未感染患者（平均差值：2037.46美元（[标准差]：482.25美元）（ 值=0.000）。最高成本组成部分是药物支出费用（平均：1612.66美元（[标准差]：2542.27美元）。
UTI是我们研究中最常见的HCAI。住院期间获得的感染可能与更高的住院费用、延长的住院时间以及死亡率增加有关。更长的住院时间、中心静脉导管和导尿管的存在、接受免疫抑制剂治疗、使用机械通气是HCAI的常见风险因素。本研究表明，有HCAIs患者每次住院的中位报销费用高于无HCAIs患者。这突出了实施HCAI预防和控制措施的必要性。
