| Objective: Central venous catheter-related bloodstream infection is one of the common nosocomial infections.When the infection occurs,the clinical manifestations are chills,fever,gastrointestinal symptoms such as nausea,vomiting,and circulation system symptoms including of hypotension,tachycardia,suppurative thrombophlebitis,pulmonary infection,endocarditis,prolonged bacteremia or fungemia,even septic shock and so on.At present in the world,especially in developing countries,central venous catheter-related bloodstream infection is still a serious complication.In China,central venous catheter-related bloodstream infection has been deemed to be one of four nosocomial infections monitored by the Chinese government now.However,there is a lack of statistic data published by the government and other strong evidences to support the prevention.Therefore,it is necessary to conduct a research about the incidence of central venous catheter-related bloodstream infection.Evaluation on the the cost attributable to central venous catheter-related bloodstream infection is equally important during the prevention and treatment of this infection.Surveillance conducted by foreign researchers had shown that the occurrence of central venous catheter-related bloodstream infection brought an additional and heavy financial burden on patients in both developed and developing countries.This additional financial burden included the cost of drug,diagnostic imaging,laboratory testing,health care technical service,medical material,etc.However,there is still no report about the cost attributable to this infetion in China now.Chinese government is trying to solve the high costs of getting medical services under the background of the new medical reform,which started from April of 2009.Distinguishing the cost between primary disease and central venous catheter-related bloodstream infection can help the government to find the origin of economic burden,and make a further evaluation of the burden from this infection itself,which is useful to establish more scientific and cost-benefit control strategies.In addition,it is also meaningful to carry out influencing factors analysis of cost attributable to central venous catheter-related bloodstream infection,which is helpful for government to make targeted strategies.Nowadays,implementing effective influencing factors analysis of medical expenditure,and controlling its rapid rise have become the global issue and the focus of social concern.However,only the cost of primary disease and its influencing factors were analyzed in the past,which was not favourable to evaluate the cost of the infection and make a further judgement on its independent risk factors.Therefore,the influencing factors such as demographic characteristics and clinical characteristics of cost attributable to central venous catheter-related bloodstream infection were analyzed in the study.Methods: 1.Incidence study: meta-analysis was used to study the percentage incidence and daily incidence.The information of incidence was selected through computer retrieval(four Chinese databases and two English databases),and manual retrieval(academic conference documents,newspapers,etc).Inclusion and exclusion criteria were set according to research period,research type,research area,and research language.For documents included,study quality was assessed,and the data were extracted.The statistical software of Stata(V12.0)was used to analyze incidence.Heterogeneity of the researches was measured using the Q statistic.When the heterogeneity was found,stratified analysis was used to analyze it.The stratified analysis on the factors including of the location of hospital,patients' demographic characteristic,and clinical characteristic was implemented.Sensitivity analysis was used to estimate whether the result of this study was stable or not,and finally to assess the publication bias,the Begg's test and Egger's test were conducted.2.Economic burden study: sample clinical departments such as intensive care unit(ICU),general surgery,and nephrology,which were prone to central venous catheter-related bloodstream infection,were selected from two hospitals in Shenyang,during January in 2011 to November in 2015.Two methods including of 1:1 matched study and case investigation were used to analyze the cost attributable to this infection.Through matched study,all the patients from the clinical departments mentioned above were included to analyze,and a total of three key variables were in the matching procedure including of age,principal diagnosis,and surgery.Meanwhile,60 patients from one sample hospital were chose to conduct case investigation,based on the information of patients' medical records and hospitalization bills.3.Influencing factors analysis: univariate and multivariate analysis of the cost from the patients in case group were carried out.On the basis of univariate analysis,a general linear model was established to study the impact of demographic characteristics of patients(sex,age,occupation,and immunosuppressive drug history),and clinical features(ICU,principal diagnosis,other diagnosis,operation level,catheter number,pathogenic microorganism)on the cost attributable to central venous catheter-related bloodstream infection.Results: 1.Incidence study: the overall pooled percentage incidence of central venous catheter-related bloodstream infection was 4.9%,and the daily incidence was 4.0 per 1000 central catheter days.With respect to the regional distribution,the highest percentage incidence was in the eastern province,which was 5.4%,followed by the central and western provinces,which were 3.6% and 1.4%,and the daily incidence of eastern provinces was also higher than that in the central and western provinces,which were 4 per 1000 central catheter days,3 per 1000 central catheter days,and 1 per 1000 central catheter days,respectively.Concerning the distribution in patients,the percentage incidence in the group of patients above 60 years old was 7.1%,which was highest,and the incidence was 1.8% in the group of patients under 18 years old,which was lowest;the incidence of this infection in female patients was 6.2%,which was slightly higher than 5.6% in male patients.With regard to the clinical features,8.6%,5.3%,4.8% through femoral vein,subclavicular vein,and internal jugular vein;2.3% within 5 days of catheterization,and 15.5% after two weeks of catheterization;3.5%,2.2%,1.5% in patients infected by gram-negative bacteria,gram-positive bacteria,and fungus,respectively.2.Economic burden study: the median cost attributable to central venous catheter-related bloodstream infection was ?24359.4 through the 1:1 matched study.The differences between median drug costs,median diagnostic imaging and other examinations' costs,median laboratory testing costs,median technical fees,and median medical material costs of the two groups were ?17633.1,?1073.6,?2937.4,?2574.4,and ?787.6,respectively.Based on 60 case investigations,the total cost including of core drug and laboratory test attributable to this infection was between ?142.3 to ?22896.8.3.Influencing factors analysis: the additional cost had statistical relations with age,catheter number,and pathogenic microorganism(P<0.15).The standardized estimate(?)of catheter number was highest,and followed by principal diagnosis,pathogenic microorganism,age,and ICU.The contribution to the model R-square attributable to the five factors(?R-square)were 11.33%,8.67%,1.76%,4.80%,and 0.64%,respectively.Conclusion: 1.Concerning the regional distribution,the incidence of central venous catheter-related bloodstream infection in eastern provinces was higher than that of western provinces.As for the patients' characteristic,it showed a higher incidence for old patients.With respect to clinical features,catheterization through femoral vein,indwelling the catheter over two weeks,and gram-negative bacteria were the main factors to increase the incidence.2.Patients had to undertake additional cost due to central venous catheter-related bloodstream infection,which significantly increased their economic burden.3.Patients with old age,inflammation,severe conditions(ICU or more catheters),and infected by fungus were likely to pay much more.The government and hospitals should pay more attention to avoid this infection.Once the infection occurred,prompt and targeted treatment should be given to control it so that the patients' economic burden could be reduced. |
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