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Clin Infect Dis:美国2010-2014年与住院治疗获得性甲氧西林敏感和甲氧西林耐药金葡菌相关的全国费用

发布日期:2018-12-15来源:clinical infectious diseases发布人:感控雏鹰

前言

金黄色葡萄球菌感染的范围从轻度皮肤和软组织感染到严重的全身性感染。由这些生物引起的感染可能对甲氧西林敏感或耐受。耐甲氧西林的第一报告金黄色葡萄球菌(MRSA)发表在1961年。从那时起,MRSA感染已达到全球流行病的比例,MRSA是美国抗生素耐药性感染导致死亡的主要原因。最近的国家报告表明,每1000例住院治疗中有近10例与MRSA相关的住院治疗; 这占所有与金黄色葡萄球菌相关的住院治疗的近60%。出于这个原因,许多医疗机构都集中在预防MRSA的,但甲氧西林敏感金黄色葡萄球菌(MSSA)感染继续造成相当数量的金黄色葡萄球菌感染。

摘要

背景

耐甲氧西林金黄色葡萄球菌(MRSA)引起的感染与较差的患者结果和较高的甲氧西林敏感(MSSA)感染相关的护理费用相关。然而,由于之前的研究发现了这些差异,医疗保健领域已发生变化,包括广泛传播与社区相关的MRSA菌株。我们试图提供MRSA感染超额成本的最新估算。

方法

我们使用来自2010 - 2014年医疗保健研究和质量机构的全国住院患者样本的数据进行了回顾性分析。我们计算了住院治疗的费用,包括MRSAMSSA相关的败血症和肺炎感染,以及来自其他地方和未指明部位的病症的MRSAMSSA相关感染(其他感染)。使用2010 - 2014年倾向评分调整后的死亡率结果估算住院费用的差异。

结果

2014年,肺炎和脓毒症相关住院治疗的估计费用最高。对于MSSA相关性肺炎(40725美元对38561美元; P=0.045)和其他住院治疗(15578美元对14792美元; P<0.001)的倾向得分调整成本显着高于MRSA相关住院治疗。尽管MSSAMRSA相关的肺炎住院治疗之间的原始成本差异从2010年的25.8%上升到2014年的31.0%,但在2010年至2013年期间观察到类似的模式。与MSSA相关的住院治疗相比,MRSA相关的住院治疗具有更高的调整死亡率率。

结论

尽管先前MRSA感染与较高的住院费用有关,但我们的结果表明,近年来,与MSSA相关的感染相关的费用已经收敛并可能超过类似MRSA相关住院治疗的费用。

National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010–2014

Abstract

Background

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been associated with worse patient outcomes and higher costs of care than methicillin-susceptible (MSSA) infections. However, since prior studies found these differences, the healthcare landscape has changed, including widespread dissemination of community-associated strains of MRSA. We sought to provide updated estimates of the excess costs of MRSA infections.

Methods

We conducted a retrospective analysis using data from the National Inpatient Sample from the Agency for Healthcare Research and Quality for the years 2010–2014. We calculated costs for hospitalizations, including MRSA- and MSSA-related septicemia and pneumonia infections, as well as MRSA- and MSSA-related infections from conditions classified elsewhere and of an unspecified site (“other infections”). Differences in the costs of hospitalization were estimated using propensity score–adjusted mortality outcomes for 2010–2014.

Results

In 2014, estimated costs were highest for pneumonia and sepsis-related hospitalizations. Propensity score–adjusted costs were significantly higher for MSSA-related pneumonia ($40725 vs $38561; P = .045) and other hospitalizations ($15578 vs $14792; P < .001) than for MRSA-related hospitalizations. Similar patterns were observed from 2010 to 2013, although crude cost differences between MSSA- and MRSA-related pneumonia hospitalizations rose from 25.8% in 2010 to 31.0% in 2014. Compared with MSSA-related hospitalizations, MRSA-related hospitalizations had a higher adjusted mortality rate.

Conclusions

Although MRSA infections had been previously associated with higher hospitalization costs, our results suggest that, in recent years, costs associated with MSSA-related infections have converged with and may surpass costs of similar MRSA-related hospitalizations.

简译人:感控雏鹰

来源:https://academic.oup.com/cid/article/68/1/22/4995458