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. 梁训宏, 吴劲松, 程锦娥, 等. 耐碳青霉烯类肠杆菌科细菌的临床分布特点及耐药性分析. 中国实用医药, 2017, 12(15): 4-7.
2. 陆文香, 许倩, 钟桥, 等. 耐碳青霉烯类肠杆菌科细菌临床感染现状分析. 国际检验医学杂志, 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, 付强, 王贵强, 等. 中国碳青霉烯耐药革兰阴性杆菌(CRO)感染预防与控制技术指引. 中华医院感染学杂志, 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. 中华人民共和国卫生部. 关于印发医院感染诊断标准（试行）的通知. (2001-11-07)[2014-01-01]. http://www.nhc.gov.cn/wjw/gfxwj/201304/37cad8d95582456d8907ad04a5f3bd4c.shtml.
11. 陈玉坤, 冀旭峰, 于立娜, 等. 某三甲医院 2016 年鲍氏不动杆菌感染的直接经济损失研究. 中华医院感染学杂志, 2019, 29(18): 2754-2758, 2762.
12. 肖婷婷. 碳青霉烯类不敏感肺炎克雷伯菌血流感染危险因素及预后分析. 杭州: 浙江大学, 2018.
13. 唐洪影, 李静, 宋缘缘, 等. 耐碳青霉烯类肺炎克雷伯菌感染及预后相关因素分析. 天津医科大学学报, 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 中国细菌耐药性监测. 中国感染与化疗杂志, 2020, 20(1): 1-10.
17. 刘凤阁, 杨楠, 杜凤芹, 等. 2011 年~2015 年某综合医院医院感染经济负担动态分析. 中国卫生事业管理, 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. 吴安华. 医院感染损失的经济学评价. 中国感染控制杂志, 2006, 5(3): 193-197.
20. 孙吉花, 姜雪锦. 倾向指数匹配法在医院感染经济负担评价中的应用. 中国感染控制杂志, 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. 陈文森, 李松琴, 李慧芬, 等. 倾向指数配比分析(PSM): MRSA 与 MSSA 医院获得性肺炎预后比较. 中国感染控制杂志, 2016, 15(5): 299-303.

West China Medical Journal

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

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