综合ICU住院患者多重耐药菌医院感染与经济负担

Multidrug-resistant organism healthcare-associated infection and economic burden in general intensive care unit patients

摘要:

目的 了解重症监护病房（ICU）多重耐药菌（MDRO）医院感染情况及其造成的经济负担。方法 回顾性调查2016-2017年某院综合ICU住院患者中发生MDRO医院感染的病例，分析MDRO医院感染率、感染部位与耐药菌种类，采用配对病例对照研究比较MDRO医院感染与非感染患者住院日数、住院费用的差异。结果 2016-2017年综合ICU住院患者MDRO医院感染率为7.5%，2017年低于2016年（4.5% vs 10.7%）。MDRO医院感染主要为下呼吸道感染（非呼吸机相关肺炎）、呼吸机相关肺炎以及手术部位感染，分别占50.0%、16.9%及10.8%。主要MDRO是耐碳青霉烯类鲍曼不动杆菌（CRAB）、耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类铜绿假单胞菌（CRPA），分别占42.9%、24.8%和24.0%。MDRO感染者较非感染者住院日数延长26.0 d，住院总费用增加116 147.0元（均P<0.001）。CRPA感染患者的住院日数最长、住院费用最高。结论 综合ICU住院患者MDRO医院感染可增加住院日数和住院费用，给患者带来巨大的经济负担，应积极采取有效的MDRO感染防控措施，规范抗菌药物合理使用。

Abstract:

Objective To investigate the occurrence of healthcare-associated infection(HAI) caused by multidrug-resistant organisms (MDROs) and economic burden due to MDRO HAI in an intensive care unit (ICU). Methods MDRO HAI occurred in patients in the general ICU of a hospital from 2016 to 2017 was investigated retrospectively, infection rate, infection site, and drug-resistant bacteria were analyzed, difference in length of hospital stay and hospitalization expenses between patients with MDRO HAI and patients without infection were compared by matched case-control study. Results MDRO HAI rate in patients in general ICU in 2016-2017 was 7.5%, MDRO HAI rate in 2017 was lower than that in 2016 (4.5% vs 10.7%). The main MDRO HAI was lower respiratory tract infection (non-ventilator-associated pneumonia), ventilator-associated pneumonia,and surgical site infection, accounting for 50.0%, 16.9%, and 10.8% respectively. The main MDROs were carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Pseudomonas aeruginosa (CRPA), accounting for 42.9%, 24.8%, and 24.0% respectively. The length of hospital stay of patients with MDRO infection were 26.0 days longer than patients without infection, and total hospitalization expenses increased by 116 147.0 yuan (all P<0.001). Patients with CRPA infection had the longest length of hospital stay and the highest hospitalization expenses. Conclusion MDRO HAI in general ICU patients can increase length of hospital stay and hospitalization expenses, and bring huge economic burden to patients, effective measures for prevention and control of MDRO infection should be taken to standardize the rational use of antimicrobial agents.