CAJ | 학술논문

目的了解耐亚胺培南鲍曼不动杆菌的医院感染对临床及医疗费用的影响.方法回顾性病例对照研究2007年1月至2009年6月于首都医科大学附属北京朝阳医院住院治疗的感染耐亚胺培南鲍曼不动杆菌患者和感染亚胺培南敏感鲍曼不动杆菌患者,分别为耐药组和敏感组,各138例.按年龄、性别、基础疾病严重程度、感染部位、住院时间及入院至出现感染的时间间隔等匹配因素随机选取敏感组患者进行1∶1配对.计量资料的组间比较采用t检验或秩和检验,计数资料的组间比较采用x2检验,多因素分析采用Logistic回归.结果耐药组院内总病死率为39.1％,明显高于敏感组的20.3％(x2=11.728,P＜0.01).138对耐药组和敏感组患者中,有72对存活,耐药组的总住院时间及住ICU时间分别为28.5d和14.5d,均明显长于敏感组的23.0d及0 d(x2 =2.886、4.844,均P＜0.01).耐药组平均每住院日的总费用为3652元,抗菌药物费用为555元,均明显高于敏感组的2092元及338元(Z=3.792、4.209,均P＜0.01).结论耐亚胺培南鲍曼不动杆菌感染可显著升高患者的住院病死率、延长住院时间及增加住院费用.
목적 료해내아알배남포만불동간균적의원감염대림상급의료비용적영향.방법 회고성병례대조연구2007년1월지2009년6월우수도의과대학부속북경조양의원주원치료적감염내아알배남포만불동간균환자화감염아알배남민감포만불동간균환자,분별위내약조화민감조,각138례.안년령、성별、기출질병엄중정도、감염부위、주원시간급입원지출현감염적시간간격등필배인소수궤선취민감조환자진행1∶1배대.계량자료적조간비교채용t검험혹질화검험,계수자료적조간비교채용x2검험,다인소분석채용Logistic회귀.결과 내약조원내총병사솔위39.1％,명현고우민감조적20.3％(x2=11.728,P＜0.01).138대내약조화민감조환자중,유72대존활,내약조적총주원시간급주ICU시간분별위28.5d화14.5d,균명현장우민감조적23.0d급0 d(x2 =2.886、4.844,균P＜0.01).내약조평균매주원일적총비용위3652원,항균약물비용위555원,균명현고우민감조적2092원급338원(Z=3.792、4.209,균P＜0.01).결론 내아알배남포만불동간균감염가현저승고환자적주원병사솔、연장주원시간급증가주원비용.
Objective To investigate the impact of antimicrobial resistance on clinical outcomes and medical care costs among patients with imipenem-resistant Acinetobacter baumannii (IRAB) nosocomial infection.Methods A retrospective matched case-control study was performed to compare the differences of clinical outcomes and medical care costs between patients with IRAB infection and patients with imipenem-susceptive Acinetobacter baumannii (ISAB) infection in a tertiary care university teaching hospital in China from January 2007 to June 2009.Cases were matched to controls with ratio of 1:1 on the basis of age,sex,severity of underlying diseases,source of infection,duration of hospitalization period and length of hospital stay before onset of infection.The measurement data between groups were compared by t test and rank test.The numeration data between groups were compared by x2 test. Multiple analysis was performed by Logistic regression.Results The total mortality rate of IRAB infection patients was significantly higher than that of ISAB infection patients (39.1％ vs 20.3 ％ ; x2 =11.728,P＜0.01).Among 138 pairs of patients in IRAB group and ISAB group,there were 72 matched case-control pairs survived,which were significantly different in length of total hospital stay (28.5 days vs 23.0 days; x2 =2.886,P＜0.01) and intensive care unit (ICU) stay (14.5 days vs 0 day; x2 =4.844,P＜0.01).For all the 138 case-control pairs,everyday total hospitalization cost and everyday antibiotic therapy cost in IRAB cases were both higher than ISAB controls (RMB 3652 yuan vs RMB 2092 yuan; Z=3.792,P＜0.01 and RMB 555 yuan vs RMB 338 yuan; Z=4.209,P＜0.01).Conclusion IRAB infection can increase the mortality rate,lengthen hospital stay and elevate the medical costs notably.