| Objective:Through the method of retrospective investigating,the renal transplant recipients undergoing surgery of a triple A hospital were surveyed.To investigate the infective status and epidemiological characteristics of renal transplant recipients.Postoperative follow-up questionnaire were designed to explore and analyse the risk factors for postoperative infection.To investigate the hospitalization cost of renal transplant recipients and analyse the direct economic losses caused by infection,for the purpose of reducing the incidence of infection and supply basis for health administrative department.Methods:1.The epidemiological characteristics of infection after renal transplantation.Using the method of cluster sampling,patients at the renal transplantion center affiliate to a triple A hospital from January 1st,2005 to December 31,2015 were selected as the subjects to research.The questionnaire about postoperative infection of renal transplant recipients were used to all eligible patients,medical data were recorded item by item.Using rate?constitute ratio to describe the types and sites of infection?pathogenic bacteria distribution and pathogenic resistance.2.Study on risk factors for postoperative infection of renal transplant recipients.Using the method of cluster sampling,postoperative follow-up patients in a renal transplantion center affiliate to a triple A hospital were selected as study subjects.Patients were divided into two groups,one group with postoperative infection as the infected group,the other one without infection as the control group.Using chi-square test to analyse the single factor,and the possible influencing factors were included in the Logistic regression model for multi-factor analysis,ultimate goal was to contrast and analyse the risk factors of infection.3.Study on direct economic burden with infection after renal transplantation.Questionnaire about hospitalization cost of renal transplantation recipients were used to all eligible patients.Devided the patients into hospital infection group and community infection group,without infection as the control group.Using the Mann-Whitney U test to compare hospitalization cost and days,difference between the median cost.Summary the cost of community infection,analyse the economic losses of hospital and community infection.Results:1.The epidemiological characteristics of infection after renal transplantation.343 renal transplant recipients were investigated,253 were male(73.8%),90 were female(26.2%),the average age was(36.75+11.5),the median hospitalization day was15,the incidence of postoperative infection was 44.6%,fatality rate of infection is12.4%.The lung infection(129,60.3%)occured the most of the infection,followed by urinary tract(43,20.2%)and the upper respiratory tract(19,8.9%).The easily infected period after renal transplantation was mainly in 6 months(128,59.8%),76.2%of patients were infected within 1 year after transplantation.The infection type after transplantation was mainly community infection(135,88.2%),hospital infection was less(18,11.8%).The mostcommon pathogens were gram-negative bacteria(54,65.1%).The resistance rate of E.coli of ceftriaxone and cefuroxime was 88.9%,acinetobacter baumannii to antibiotics was100%except imipenem,gas enterbacteriaceae to ceftriaxone was 88.3%,klebsiella pneumoniae to ceftriaxone was 100%.In gram-positive bacterium,the resistant rate of enterococcus to minocycline was 50%,to penicillin,erythromycin,ampicillin,gentamicin resistant rate were all 66.7%,to rifampicin,levofloxacin were 100%.2.Study on risk factors for postoperative infection of renal transplant recipients.2.1 Chi-square test result showed that the occurrence of infection was associated with patients'annual income,preoperative albumin values,whether prophylactic use of antifungal drugs,cognition of infection,always dine at home,a small wound is handled in time,frequency out of the public,whether wearing masks and hats in public,whether prolonged bed time after transplantation,whether exercising after operation and self-care.2.2 Logistic regression analysis results showed that white blood cells?4*10~9/L(OR=0.079,95%CI=0.079~0.305),always dine at home(OR=0.079,95%CI=0.079~0.305),to protect oneself with masks and hats in public(OR=0.049,95%CI=0.049~0.264)were protective factors.Albumin(27)35 g/L(OR=6.339,95%CI=1.320~30.437),frequency in public places(29)15 times a month(OR=4.044,95%CI=4.044~9.658),immunosuppressants blood drug concentration higher than normal(OR=3.759,95%CI=3.759~8.436)were independent risk factors after transplantation.3.Study on direct economic burden with infection after renal transplantation.3.1 The median hospitalization cost of patients in the hospital infection group was157882.25 yuan,while the control group was 86694.90 yuan,the medicine and treatment accounted the largest in both of the groups.The hospitalization cost of control group,was significantly lower than the hospital infection group the difference was 71187.35 yuan,and the difference was statistically significant(Z=-5.95,P=0.000).The hospitalization expenses increased by hospital infection were mainly the treatment fee and the medicine fee,the difference of the medicine cost was 49478.25 yuan,the therapy cost was8670.53 yuan.The hospitalization cost caused by community infection was 33150.8 yuan,the medicine fee and laboratory fee accounted the largest in the cost,the media medicine fee was 23411.71yuan,the media laboratory fee was 2305.25yuan.3.2 The media hospitalization day in the hospital infection group was 30.5 days,while the control group was 16 days,the difference between two groups was 14.5 days,statistically significant(P(27)0.05).The hospitalization day in the community infection group was 14days.3.3 The direct economic loss varied from infection sites.The total cost of hospital infection group was multi-site infection(29)pulmonary infection(29)urinary tract infection(29)SSI infection(29)other sites infection.The total cost.The total cost of community infection was multi-site infection(29)urinary tract infection(29)pulmonary infection(29)upper respiratory tract infection(29)other sites infection.3.4 The direct economic losses caused by infection in the community infection group increases with the age of the patient.The median hospitalization expense under the age of18 patients was 15825.13 yuan,18 to 30 years old group of patients was 26993.21 yuan,31 to 60 years old group was 38158.86 yuan,more than 60 patients cost the most,it was70080.2 yuan.Conclusion:1.The incidence of infection after renal transplantation was high,community infections accounts for the majority.The time was mainly concentrated in 1 year after transplantation,and the pathogenic bacteria were mainly gram-negative bacteria.2.White blood cells?4*10~9/L,always dine at home,to protect oneself with masks and hats in public were protective factors after transplantation.Albumin(27)35 g/L,frequency in public places(29)15 times a month,immunosuppressants blood drug concentration is higher than normal were independent risk factors after transplantation.3.The direct economic loss caused by infection after kidney transplantation is relatively large.Medicine and therapy cost accounted for the largest two parts of cost in patients with hospital infection.Medicine and laboratory fees were the mainly costs in patients with community infection.In two groups,the multi-site infection costed the most in all infection sites,followed by was lung infection in hospital infection,urinary tract infection in community infection group. |
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