Nguyen Nga Thi-Quynh, Nguyen Nhien Phan-Thuy, Truong Quynh Thuy, Huynh Thao Phuong, Tran-Thi Hong-Nguyen, Hoang Minh Van, Nguyen-Thi Hai-Yen
Department of Pharmaceutical Administration, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Department of Pharmacy, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
PLoS One. 2025 Aug 4;20(8):e0329539. doi: 10.1371/journal.pone.0329539. eCollection 2025.
Despite the increasing burden of antimicrobial resistance (AMR), specifically on priority ESKAPE pathogens, studies examining the economic impact of AMR in low- and lower-middle-income countries have been scarce and require further investigation to optimize the post-COVID resource allocation.
To quantify the incremental hospital costs and length of stay (LOS) associated with antimicrobial-resistant versus -susceptible among priority ESKAPE pathogens from the healthcare sector perspective.
We conducted a retrospective observational study of patients hospitalized at the Hospital for Tropical Diseases from 2016-2021 with non-duplicate isolates of any ESKAPE pathogens from clinical specimens. The patients were then stratified into resistant- and susceptible- groups by the WHO classification. Multivariate generalized linear regression and negative binomial regression with linear spline at COVID-19 occurrence were employed to evaluate the incremental hospital costs and LOS due to AMR, respectively. These regressions were adjusted for sociodemographic and clinical characteristics. We applied difference-in-difference (DiD) to estimate the differential cost between resistant and susceptible groups regarding COVID-19 change.
During the six-year period, 4,197 out of 6,670 patients (62.92%) were isolated with priority pathogens, with the highest prevalence of priority pathogens observed in 3GCREC and MRSA (accounting for 45.63% and 25.33%, respectively). After covariate adjustments, the incremental hospital costs per resistant patient were significantly higher across most pathogens except for patients tested with MRSA results (average CRAB $3,980; CRPA $1,000; 3GCREC $444; 3GCRKP $1,942; MRSA -$326), while incremental LOS ranged from 1.40 days for 3GCREC (95%CI: 0.69-2.10 ) to 12.54 days for CRPA (95%CI: 11.12-13.97). COVID-19 significantly enlarged the hospital cost gaps between patients with antibiotic-resistant and antibiotic-susceptible profiles, with A.baumannii (CRAB vs. CSAB) showing the highest DiD at $9,116 (95%CI: $6,019-$12,213).
The incremental hospital costs of AMR were significant, with the highest one observed in CRAB patients, and the difference between resistant and susceptible cases widened during the COVID-19 pandemic.
尽管抗菌药物耐药性（AMR）的负担日益加重，尤其是对重点ESKAPE病原体而言，但针对低收入和中低收入国家AMR经济影响的研究却很匮乏，需要进一步开展调查以优化新冠疫情后的资源分配。
从医疗保健部门的角度，量化重点ESKAPE病原体中抗菌药物耐药与敏感情况相关的住院费用增量和住院时间（LOS）。
我们对2016年至2021年期间在热带病医院住院、临床标本中分离出任何ESKAPE病原体且无重复菌株的患者进行了一项回顾性观察研究。然后根据世界卫生组织的分类将患者分为耐药组和敏感组。采用多变量广义线性回归以及在新冠疫情发生时带有线性样条的负二项回归，分别评估AMR导致的住院费用增量和住院时间。这些回归对社会人口学和临床特征进行了调整。我们应用双重差分法（DiD）来估计耐药组和敏感组在新冠疫情变化方面的成本差异。
在这六年期间，6670名患者中有4197名（62.92%）分离出了重点病原体，在3GCREC和耐甲氧西林金黄色葡萄球菌（MRSA）中观察到重点病原体的患病率最高（分别占45.63%和25.33%）。经过协变量调整后，除了MRSA检测结果的患者外，大多数病原体中每名耐药患者的住院费用增量显著更高（平均鲍曼不动杆菌 $3980；肺炎克雷伯菌 $1000；3GCREC $444；3GCRKP $1942；MRSA -$326），而住院时间增量范围从3GCREC的1.40天（95%置信区间：0.69 - 2.10）到肺炎克雷伯菌的12.54天（95%置信区间：11.12 - 13.97）。新冠疫情显著扩大了抗生素耐药和抗生素敏感患者之间的住院费用差距，鲍曼不动杆菌（CRAB与CSAB相比）的双重差分最高，为9116美元（95%置信区间：6019美元 - 12213美元）。
AMR导致的住院费用增量显著，在CRAB患者中观察到的增量最高，并且在新冠疫情期间耐药和敏感病例之间的差异有所扩大。
