泛抗藥性鮑氏不動桿菌對加護病房病患醫療費用及臨床之影響

本研究探討泛抗藥性 (pandrug-resistant) Acinetobacter baumannii (PDRAb) 對加護病房病患醫療費用及臨床之影響。以2010年11月1日至2011年4月30日成人加護病房PDRAb 移生或感染的20位病人為病例組，2009年5月1日至2011年4月30成人加護病房非泛抗藥性A. baumannii移生或感染的20位病人為對照組。臨床方面，入院日到採檢出A. baumannii間隔 (13.5 vs. 8.5天，P=0.04)，意味住院越久，PDRAb移生或感染機會增加。醫療費用方面，分為病患醫療費用及病例組隔離成本兩部分。前者分為5項目: 住院總醫療費用、抗生素費用、加護病房醫療費用、加護病房抗生素費用、驗出A. baumannii後住院醫療費用，二組比較統計上皆無顯著差異。病例組隔離成本以每日平均隔離次數約為32次為計算基礎，依執行隔離措施過程分為隔離耗材成本 (包括清洗防水隔離衣、健檢手套、外科口罩，每人每日平均需新台幣148.6元)、隔離時間成本 (工作人員所花費時間轉換成平均薪資，每人每日平均147.2元)、檢驗成本 (額外增加細菌培養檢驗費用，每人每日平均75.6元)、清潔成本 (消毒錠費用，每人每日平均3.1元)，合計在加護病房隔離耗費每人每日平均374.5元。目前國內外在醫院執行PDRAb感染管制措施成本之研究，十分少見，本研究調查加護病房每一名PDRAb病患每天執行隔離防護措施平均次數及平均需增加多少隔離成本，以提供醫療機構管理者及工作人員參考。

關鍵字

PDRAb ；醫療費用；隔離成本；隔離防護措施

並列摘要

To investigate the impact of pandrug-resistant Acinetobacter baumannii (PDRAb) on economic and clinical outcomes in intensive care unit patients, a case-control study was conducted to explore the difference in clinical and economic outcomes. The study period was from Nov. 1th, 2010 to Apr. 30th, 2011 in cases with PDRAb and May 1th, 2009 to Apr. 30th, 2011 in controls colonization/infection with A. baumannii (non-PDR). In statistical analysis, the length of admission reached statistical significance between cases and controls (13.5 vs. 8.5 days, P=0.04), suggesting that the opportunity of colonization/infection with PDRAb was increased. The impact of economic was divided into the costs of hospitalization and the costs of cases implemented isolation precautions. Further, the costs of hospitalization was categorized as total hospitalization costs, total antibiotics costs, hospitalization costs in intensive care unit (ICU), antibiotics costs in ICU, and the costs of the duration of inspected sample in A. baumannii to discharge. However, no statistical significance was observed between cases and controls. The implementation of isolation precautions by 32 times daily were calculated on the basis. The average costs for every person per day (new Taiwan dollars) was about 148.6 in isolation supplies (including clean isolation gowns, gloves, surgical masks), 147.2 in staff salary calculated by working time,75.6 in inspection costs (additional culture test of bacteria), 3.1 in cleaning costs (disinfection tablets). The summations of average costs for every person per day were 374.5 new Taiwan dollars. So far, the data of research on the average time of implementation of isolation precautions and the average costs of isolation was insufficient. In this study, we investigated the impact of patients with PDRAb on the economic and clinical outcomes in ICU. In the further, this study may provide the references for hospital administrators and staff to execute protective suitably measures for patients with PDRAb.

並列關鍵字

PDRAb ； hospitalization costs ； isolation costs ； isolation precautions

參考文獻

行政院衛生署疾病管制局(民101)。台灣院內感染監視資訊系統 (TNIS) 100年度第三季監視報告。台北市：疾病管制局

Abbo, A., Carmeli, Y., Navon-Venezia, S., Siegman-Igra, Y., & Schwaber, M. J. (2007). Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes. [Research Support, Non-U.S. Gov't]. Eur J Clin Microbiol Infect Dis, 26(11), 793-800. doi: 10.1007/s10096-007-0371-8

Apisarnthanarak, A., Pinitchai, U., Thongphubeth, K., Yuekyen, C., Warren, D. K., & Fraser, V. J. (2008). A multifaceted intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in 3 intensive care units in a Thai tertiary care center: a 3-year study. [Research Support, Non-U.S. Gov't]. Clin Infect Dis, 47(6), 760-767. doi: 10.1086/591134

Barchitta, M., Cipresso, R., Giaquinta, L., Romeo, M. A., Denaro, C., Pennisi, C., & Agodi, A. (2009). Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. [Research Support, Non-U.S. Gov't]. Int J Hyg Environ Health, 212(3), 330-337. doi: 10.1016/j.ijheh.2008.07.001

Caricato, A., Montini, L., Bello, G., Michetti, V., Maviglia, R., Bocci, M. G., Antonelli, M. (2009). Risk factors and outcome of Acinetobacter baumanii infection in severe trauma patients. Intensive Care Med, 35(11), 1964-1969. doi: 10.1007/s00134-009-1582-5

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泛抗藥性鮑氏不動桿菌對加護病房病患醫療費用及臨床之影響

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