Direct economic burden of healthcare-associated infection with carbapenem-resistant Enterobacteriaceae_West China Medical Journal

Authors：

YAN Huizhu ¹ , Lü Yu ² ,  FANG Ying ³

1. Intensive Care Unit, Jianyang People’s Hospital, Jianyang, Sichuan 641400, P. R. China;
2. Healthcare-associated Infections Control Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;
3. Department of Infection Management, Jianyang People’s Hospital, Jianyang, Sichuan 641400, P. R. China;

Corresponding?author：

FANG Ying, Email: 1135531579@qq.com

Keywords：

Carbapenem-resistant Enterobacteriaceae; Propensity score matching; Direct economic burden

DOI：

10.7507/1002-0179.202004359

Video：

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Objective To study the direct economic burden of hospitalization in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection.Methods Patients with CRE detected in Jianyang People’s Hospital between January 2017 and June 2019 were divided into infection group and colonization group, and multiple linear regression analysis was used to analyze the confounding factors, and then propensity score matching method was used to match the confounding factors of the two groups, finally the direct economic burden of hospitalization was compared between the two groups.Results A total of 2 013 patients were enrolled, including 507 CRE-infected patients and 1 506 CRE-colonized patients. Multiple linear regression results showed that factors affecting the direct economic burden of hospitalization included mechanical ventilation, intravenous catheterization, blood transfusion or use of blood products, urinary intubation, tracheotomy, gender, surgery, intensive care unit stay, main diagnosis, and the type of medical insurance, together with CRE infection (P<0.05). After propensity score matching, these confounding factors were well balanced between the infection group (n=249) and the colonization group (n=249), and the differences were not statistically significant (P>0.05). The median of total hospitalization cost of CRE-infected patients was 1.29 times (15 589.23 yuan more than) that of CRE-colonized patients and the difference between the two groups was statistically significant (Z=–3.116, P=0.002). The top two types of hospitalization cost with largest differences in the medians were the cost of Western medicine (4 850.21 yuan; Z=–3.460, P=0.001) and the cost of laboratory diagnosis (2 613.00 yuan; Z=–3.529, P<0.001), respectively. The cost of antimicrobial drugs differed significantly between the two groups (Z=–3.391, P=0.001), and it was 1.54 times in patients with CRE infection what it was in patients with CRE colonization.Conclusions There are many factors affecting the direct economic burden of inpatients, and it is necessary to avoid the influence of confounding factors as far as possible during analysis. The economic burden of patients with CRE infection is significantly greater than that of CRE-colonized patients, so active measures should be adopted to prevent and control CRE infection.

Citation： YAN Huizhu, Lü Yu, FANG Ying. Direct economic burden of healthcare-associated infection with carbapenem-resistant Enterobacteriaceae. West China Medical Journal, 2021, 36(3): 334-340. doi: 10.7507/1002-0179.202004359 Copy

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1. 梁訓宏, 吳勁松, 程錦娥, 等. 耐碳青霉烯類腸桿菌科細菌的臨床分布特點及耐藥性分析. 中國實用醫藥, 2017, 12(15): 4-7.
2. 陸文香, 許倩, 鐘橋, 等. 耐碳青霉烯類腸桿菌科細菌臨床感染現狀分析. 國際檢驗醫學雜志, 2015(13): 1861-1863.
3. Martirosov DM, Lodise TP. Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae. Diagn Micr Infec Dis, 2016, 85(2): 266-275.
4. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. Atlanta, GA: U. S. Department of Health and Human Services, CDC, 2019.
5. Tacconelli E, Carrara E, Savoldi AA, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis, 2018, 18(3): 318-327.
6. 胡必杰, 付強, 王貴強, 等. 中國碳青霉烯耐藥革蘭陰性桿菌(CRO)感染預防與控制技術指引. 中華醫院感染學雜志, 2019, 29(13): 2075-2080.
7. Porreca AM, Sullivan KV, Gallagher JC. The epidemiology, evolution, and treatment of KPC-producing organisms. Curr Infect Dis Rep, 2018, 20(6): 13.
8. Gomez-Simmonds A, Uhlemann AC. Clinical implications of genomic adaptation and evolution of carbapenem-resistant Klebsiella pneumoniae. J Infect Dis, 2017, 215(Suppl_1): S18-S27.
9. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twenty-third informational supplement. M100-S27. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute, 2017.
10. 中華人民共和國衛生部. 關于印發醫院感染診斷標準（試行）的通知. (2001-11-07)[2014-01-01]. http://www.nhc.gov.cn/wjw/gfxwj/201304/37cad8d95582456d8907ad04a5f3bd4c.shtml.
11. 陳玉坤, 冀旭峰, 于立娜, 等. 某三甲醫院 2016 年鮑氏不動桿菌感染的直接經濟損失研究. 中華醫院感染學雜志, 2019, 29(18): 2754-2758, 2762.
12. 肖婷婷. 碳青霉烯類不敏感肺炎克雷伯菌血流感染危險因素及預后分析. 杭州: 浙江大學, 2018.
13. 唐洪影, 李靜, 宋緣緣, 等. 耐碳青霉烯類肺炎克雷伯菌感染及預后相關因素分析. 天津醫科大學學報, 2019, 25(3): 271-274, 284.
14. Daikos GL, Tsaousi S, Tzouvelekis LS, et al. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems. Antimicrob Agents Chemother, 2014, 58(4): 2322-2328.
15. Bartsch SM, McKinnell JA, Mueller LE, et al. Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States. Clin Microbiol Infect, 2017, 23(1): 48.e9-48.e16.
16. 胡付品, 郭燕, 朱德妹, 等. 2018 年 CHINET 中國細菌耐藥性監測. 中國感染與化療雜志, 2020, 20(1): 1-10.
17. 劉鳳閣, 楊楠, 杜鳳芹, 等. 2011 年~2015 年某綜合醫院醫院感染經濟負擔動態分析. 中國衛生事業管理, 2017, 34(5): 330-334.
18. Huang W, Qiao F, Zhang Y, et al. In-hospital medical costs of infections caused by carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis, 2018, 67(Suppl_2): S225-S230.
19. 吳安華. 醫院感染損失的經濟學評價. 中國感染控制雜志, 2006, 5(3): 193-197.
20. 孫吉花, 姜雪錦. 傾向指數匹配法在醫院感染經濟負擔評價中的應用. 中國感染控制雜志, 2018, 17(9): 797-800.
21. Vasudevan A, Memon BI, Mukhopadhyay A, et al. The costs of nosocomial resistant Gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome: a propensity matched case control study. Antimicrob Resist Infect Control, 2015, 4(1): 3.
22. 陳文森, 李松琴, 李慧芬, 等. 傾向指數配比分析(PSM): MRSA 與 MSSA 醫院獲得性肺炎預后比較. 中國感染控制雜志, 2016, 15(5): 299-303.

West China Medical Journal

Direct economic burden of healthcare-associated infection with carbapenem-resistant Enterobacteriaceae

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