Surveillance Of Drug-resistant Bacteria Infection And Direct Economic Burden In Patients With ICU

ObjectiveTo study the related factors of multi-drug resistant bacteria infection in critically ill patients by screening drug-resistance bacteria in a grade three hospital and making suggestions for prevention.Evaluating the direct economic burden caused by multiple drug-resistant infection through analyzing the hospitalized cost and the length of stay so as to supply scientific foundation for medical administrative departments to develop relevant principles.MethodsUsing of cluster sampling methods,454 patients admitted to intensive care unit of a tertiary teaching hospital in Shandong during the year of 2016 were chosen.Two contents were researched.1.Risk factors of multi-drug resistant bacteria infections:all patients were monitored and then filled in the self-designed forms.Two people entered the data to SPSS 19.0.Characteristic information was described with mean and standard deviation,prevalence,proportions and etc.Logistic regression analysis and Chi square test was used to analyze the risk factors of multi-drug resistant bacteria infection.2.Direct economic burden:patients with drug-resistant bacteria infection were described as case group and those without were control group.Hospitalization expenses and the length of stay between the two groups were compared after matching.Mean,standard deviation,constituent ratio was used to describe the demographic data and median was used to describe average hospitalized costs and hospitalization time.Difference between groups was used rank sum test.Results1.454 ICU patients were enrolled and 272 patients were male.The patients' age between 18-94 years old and the average age was 59.10±19.97 years old.2.The number of patients with drug-resistant bacteria infection was 131and accounted for 28.90%.There were 178 cases of drug-resistant bacteria infection and the infection rate was 39.20%.3.Lower respiratory tract infection was the most in this study,accounting for 60.67%.Followed by bloodstream infection and accounting for 18.54%.The surgical site infection was in the third place and accounting for 12.36%.4.238 drug-resistant strains were detected from 131 patients.180 strains were Gram-positive bacteria(75.63%)and 50 strains were Gram-negative bacteria(21.01%).The top three Gram-positive bacteria included 67 strains of Acinetobacter baumannii(28.15%),26 strains of Pseudomonas aeruginosa(10.92%)and 20 strains of Klebsiella pneumoniae(8.40%).Besides,8 strains of fungi were detected(3.36%).5.Drug-resistant bacteria infection was associated with age,length of stay,APACHE ? score,underlying disease,antimicrobial drug,application of antimicrobial agents prior to ICU,mechanical ventilation,hemofiltration,invasive procedures(P<0.05).6.Length of stay,APACHE ? score,underlying disease,application of antimicrobial agents prior to ICU,mechanical ventilation were analyzed dependent risk factors of drug-resistant bacteria infection by logistic regression.7.The additional hospitalization cost was 93 067yuan per case in the infection group.Western medicine expense was the most(44 832yuan),followed by treatment costs(16 051).8.The average length of hospital stay was 22 days in case group,which was longer 15 days than control group.9.The economic burden of surgical site infection was the most(136 456yuan).The second was multiple parts infection(111 266yuan).No matter which infection,western medicine costs was the most.10.The direct economic burden of Pseudomonas aeruginosa infection was up to 135 014yuan,followed by Bauman acinetobacter infection patients(79 206yuan).No matter which kind of drug-resistant bacteria infection,the highest increase was western medicine costs.ConclusionThe prevalence of drug-resistant bacteria infection in patients with ICU is high.The independent risk factors of drug-resistant bacterial infections included hospitalization days,APACHE II score,mechanical ventilation,underlying diseases,and the use of antibiotics before ICU.Medical staff should take preventive measures according to the risk factors to reduce the incidence of drug-resistant bacteria infection.The economic burden of patients with drug-resistant bacteria infection will be aggravated,and the hospitalization time will be prolonged and the hospitalization cost will be increased significantly.