Background

Carbapenem-producing Enterobacterales are an expanding group of Gram-negative bacteria that are resistant to carbapenems and cause over 9000 cases of hospital-associated infections in the USA. Efforts to quantify the economic and societal burden to healthcare are important to inform resource planning to implement infection control programmes.

Aim

We estimated the healthcare costs during an outbreak of carbapenemase-producing Escherichia coli OXA-181 in Australia. We aimed to understand the economic burden to hospitals of patients who are asymptomatically colonized with high-risk bacteria.

Methods

Hospital admissions data and associated costs were obtained from the State Health Department. Colonized patients were matched to non-colonized patients on age, sex, admission ward and diagnostic category. Mean healthcare costs and length of stay were examined using generalized linear models and accounted for time-dependent bias, patient age and ward location.

Findings

On average, colonized patients had six times higher mean costs (AU$155,784; 95% confidence interval (CI): AU$77,892–285,604) than non-colonized patients (AU$25,964). Mean costs for those aged 75–79 years were 50% lower (P=0.02) compared with the youngest subgroup, 35–39 years of age. The mean extended length of stay was 12 days (95% CI: 3–21) for colonized patients. Nursing care was the main driver of overall costs for colonized (44%) and non-colonized (39%) patients.

Conclusion

Patients colonized with carbapenem-producing Enterobacterales during an official hospital outbreak incurred higher costs than non-colonized patients. Although infected patients incur substantial economic burden to hospitals, the costs incurred by colonized patients is also high.

中文翻译：

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在澳大利亚爆发期间，因产生碳青霉烯酶的肠杆菌定植的患者的住院费用。

背景

产生碳青霉烯的肠杆菌是革兰氏阴性细菌的不断扩大的群体，这些细菌对碳青霉烯类具有抗药性，在美国引起9000例医院相关感染的病例。量化对医疗保健造成的经济和社会负担的工作对于为实施感染控制计划的资源计划提供依据至关重要。

目标

我们估计了澳大利亚发生碳青霉烯酶的大肠杆菌OXA-181爆发期间的医疗保健费用。我们旨在了解无症状地被高危细菌定植的患者对医院的经济负担。

方法

医院的入院数据和相关费用是从国家卫生部获得的。在年龄，性别，入院病房和诊断类别方面，定植的患者与非定植的患者匹配。使用广义线性模型检查了平均医疗保健费用和住院时间，并考虑了时间依赖性偏差，患者年龄和病房位置。

发现

平均而言，定植患者的平均费用（155,784澳元； 95％置信区间（CI）：77,892-285,604澳元）是未定植患者（25,964澳元）的六倍。与年龄最小的35-39岁小组相比，年龄75-79岁的小组的平均费用降低了50％（P = 0.02）。对于定植的患者，平均延长住院时间为12天（95％CI：3-21）。护理是殖民（44％）和非殖民（39％）患者总费用的主要驱动力。

结论

在正式医院爆发期间被产生碳青霉烯的肠杆菌定植的患者比未定殖的患者产生的费用更高。尽管被感染的患者给医院带来了巨大的经济负担，但定植患者的费用也很高。