ICU住院患者耐药菌感染监测及直接经济负担研究

发布时间：2018-02-12 02:53

本文关键词： ICU 住院患者耐药菌感染经济负担　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过对某三甲医院ICU住院患者耐药菌感染进行目标性监测,了解危重患者多重耐药菌感染的相关因素;了解ICU耐药菌感染患者的各项住院费用及住院时间,评估患者因耐药菌感染所造成的直接经济负担,为临床预防用药、治疗和为卫生部门制订切实有效的感染控制政策提供参考。方法采用整群抽样的方法,研究对象均为2016年1月1日至2016年12月31日入住山东省某三甲医院ICU的住院患者,共计454例。包括两方面的内容:(1)ICU住院患者耐药菌感染的相关因素:填写自行设计的《ICU住院患者耐药菌感染目标性监测调查表》,对患者进行目标监测。(2)ICU住院患者耐药菌感染直接经济负担研究:将感染组与对照组按照一定条件进行匹配,比较两组患者之间住院费用和住院天数的差异。数据资料录入SPSS19.0(Statistical Package for Social Sciences,version 19.0)统计软件。一般资料采用均数±标准差、率、百分比、构成比等,危险因素分析采用卡方检验和Logistic回归分析等。患者的住院费用和住院天数用中位数表示,两组之间的比较采用秩和检验。结果1.共纳入符合条件的ICU住院患者454例,其中男性272例,女性182例,患者年龄18～94岁,平均年龄59.10±19.97岁。2.纳入的454例研究对象,耐药菌感染131例,感染率为28.90%,感染例次178例,感染例次率39.20%。3.下呼吸道感染是ICU住院患者耐药菌感染常见的部位,占60.67%,其次是血流感染,占18.54%,第三位的是手术部位感染,占12.36%。4.131例发生耐药菌感染的住院患者中,共检出耐药菌238株,其中G-细菌180株,占75.63%,G+细菌50株,占21.01%。G-细菌前三位的是鲍曼不动杆菌67株(28.15%),铜绿假单胞菌26株(10.92%),肺炎克雷伯杆菌20株(8.40%),另外,检出真菌8株(3.36%)。5.ICU住院患者耐药菌感染与年龄、住院天数、APACHEⅡ评分、基础疾病、抗菌药物应用、入ICU前抗菌药物应用、机械通气、血液滤过、侵入性操作有关,(P0.05),与性别、入院季度无关(P0.05)。6.Logistic回归分析显示ICU住院患者耐药菌感染的独立危险因素是住院天数、APACHE Ⅱ评分、机械通气、基础疾病、有无手术、入ICU前抗菌药物使用。7.ICU住院患者耐药菌感染后额外增加总的医疗费用为93067元/例,其中西药费的支出最多,为44832元/例,其次为治疗费,为16051元/例。8.耐药菌感染组平均住院22天/例,较未发生感染者延长15天/例。9.手术部位耐药菌感染直接经济损失最多,为136456元/例,其次为两个以上部位感染的患者,为111266元/例。不管哪个部位的感染,增加最多的均为西药费。10.铜绿假单胞菌感染患者直接经济损失最多,为135014元/例,其次为鲍曼不动杆菌感染患者,为79206元/例。不管哪种耐药菌的感染,增加最多的均为西药费。结论ICU住院患者耐药菌感染发生率较高。发生耐药菌感染独立的危险因素主要包括住院天数、APACHEⅡ评分、机械通气、基础疾病、有无手术、入ICU前抗菌药物应用等。医护人员应根据上述危险因素针对性的采取预防控制措施,减少耐药菌感染的发生。耐药菌感染发生后会加重患者的经济负担,表现为患者住院费用显著增加,住院时间明显延长。
[Abstract]:Objective to conduct targeted monitoring of drug-resistant bacteria infection in patients with ICU hospitalized in a hospital, to understand the related factors of multi drug resistant bacteria infection in critically ill patients; understand the hospitalization expenses and hospitalization time of the patients of ICU infection of drug-resistant bacteria, evaluation of patients caused by infection of drug-resistant bacteria of the direct economic burden for clinical prevention and treatment for drug health departments to formulate effective infection control policies to provide a reference. Methods using the cluster sampling method, the subjects were hospitalized ICU patients in a hospital from January 1, 2016 to December 31, 2016 in Shandong Province, a total of 454 cases. The content includes two aspects: (1) the related factors of drug-resistant bacteria infection in patients hospitalized for ICU: complete design the resistant bacteria infection in hospitalized patients, the target monitoring on the patients. (2) study on the direct economic burden of patients with drug-resistant bacteria infection in ICU The infection group were matched according to certain conditions and the control group, the difference between the two groups were compared. The hospitalization days and expense data entry in SPSS19.0 (Statistical Package for Social Sciences, version 19) statistical software. The general data by the mean and standard deviation, rate, percentage, proportion, analyze the risk factors chi square test and Logistic regression analysis. The cost of hospitalization and hospitalization for median, between the two groups were compared using Wilcoxon test. Results 1. of the eligible 454 cases of hospitalized patients with ICU, in which male 272 cases, female 182 cases, 454 cases of patients 18~94 years of age, the mean age of the subjects 59.10 + 19.97 years included in.2., 131 cases of drug resistant bacteria infection, the infection rate was 28.90%. The infection cases in 178 cases, the infection rate of 39.20%.3. lower respiratory tract infection is a common site of drug resistant bacteria infection in hospitalized patients with ICU, Accounted for 60.67%, followed by the bloodstream infection, accounted for 18.54%, third is a surgical site infection, accounting for 12.36%.4.131 cases of hospitalized patients with drug-resistant infections, antibiotic resistant bacteria were detected in 238 strains, including 180 strains of bacteria G-, G+ accounted for 75.63%, 50 strains of bacteria, 21.01%.G- bacteria accounted for three of the Bauman Acinetobacter 67 strains (28.15%), 26 strains of Pseudomonas aeruginosa (10.92%), 20 strains were Klebsiella pneumoniae (8.40%), in addition, 8 strains of Candida (3.36%) patients with.5.ICU resistant bacteria infection and age, hospitalization time, APACHE score, basic diseases, antibacterial drugs application, ICU antibacterial application of Medicine, mechanical ventilation, blood filtration, invasive operation, (P0.05), and gender, admission quarter independent (P0.05).6.Logistic regression analysis showed that ICU were independent risk factors of drug resistant bacteria infection in patients with the hospitalization time, APACHE score, mechanical ventilation, basic disease, with or without surgery, before admission to ICU The use of antibacterial drugs in patients with.7.ICU resistant bacterial infection after hospitalization additional total medical cost of 93067 yuan / cases, including western medicine expenses up to 44832 yuan / case, the second is treatment fee, 16051 yuan / cases of.8. resistant bacteria infection group, the average hospitalization days were 22 cases with / without infection, prolonged 15 day /.9. cases of surgical site infection of drug-resistant bacteria in direct economic losses up to 136456 yuan / case, followed by more than two sites of infection, 111266 yuan / cases. No matter which part of the infection, the largest increase was the cost of Western medicine.10. Pseudomonas aeruginosa infection in patients with the most direct economic loss of 135014 yuan. / cases, followed by Bauman Acinetobacter infection patients, 79206 yuan / cases. No matter what kind of drug resistant bacteria infection, the largest increase are medicine fee. Higher incidence of drug-resistant bacteria infection in hospitalized patients. Conclusion ICU dangerous drug resistant bacteria infection independent factors. The duration of hospitalization, APACHE score, mechanical ventilation, basic disease, with or without surgery, ICU before the application of antimicrobial agents. The medical staff should be based on these risk factors take targeted prevention and control measures, reduce the occurrence of drug resistant bacteria infection. After will increase the economic burden of patients infected with drug-resistant bacteria showed a significant increase the cost of hospitalization, hospitalization time was significantly prolonged.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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