耐甲氧西林金黄色葡萄球菌感染病例对经济损失与住院日影响的对照研究

目的探讨耐甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)感染造成的经济损失。方法回顾性调查2012年1月-2013年12月456例MRSA感染和250例MSSA感染患者的住院费用与住院天数,并按照1∶1匹配设立对照组,比较各组的住院费用和住院天数。结果 MRSA感染组、MSSA感染组住院费用分别增加82 694.8元和18 735.3元,延长住院天数14.1d和5.9d;ICU中MRSA感染增加费用最高,为153 344.5元,延长住院天数则以外科明显;60⁷5岁MRSA造成的直接经济损失最高,达100 208.9元,延长住院天数22d;MSSA感染造成的经济损失则以>75岁组最大,直接经济损失23 914.4元,延长住院天数6.9d。结论 MRSA感染增加患者经济负担,延长住院时间,同时也影响医院病床周转率。     

利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌致呼吸机相关性肺炎的效果

目的 探讨利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)所致呼吸机相关性肺炎(VAP)的疗效及安全性,为临床诊断治疗提供决策依据.方法 对68例MRSA所致VAP患者随机分为利奈唑胺组和万古霉素组,每组各34例,两组的疗程均为7～14 d;比较两组患者的疗效、细菌清除率、炎性反应及不良反应发生情况.结果 利奈唑胺组MRSA清除率为73.5％、总有效率为64.7％,均显著高于万古霉素组55.9％、44.1％,差异有统计学意义(P＜0.05);与治疗前比较,两组治疗后白细胞、前降钙素及C反应蛋白水平均显著下降(P＜0.05),利奈唑胺组白细胞、前降钙素及C反应蛋白水平下降程度显著优于万古霉素组,差异有统计学意义(P＜0.05);两组不良反应发生率分别为8.8％、14.7％,差异无统计学意义.结论 利奈唑胺治疗MRSA所致VAP疗效优于万古霉素,可明显提高细菌清除率,减轻肺部炎性反应,不良反应少.     

An application of mixture distributions in modelization of length of hospital stay

Length of hospital stay (LOS) is an important indicator of the hospital activity and management of health care. The skewness exhibited by this variable poses problems in statistical modeling. The aim of this work is to model the variable LOS within diagnosis-related groups (DRG) through finite mixtures of distributions. A mixture of the union of Gamma, Weibull and Lognormal families is used in the model, instead of a mixture of a unique distribution family. Some theoretical questions regarding the model, such as the identifiability and study of asymptotic properties of ML estimators, are analyzed. The EM algorithm is proposed for performing these estimators. Finally, this new proposed model is illustrated by using data from different DRGs.     

利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌肺炎的对照研究

目的探讨利奈唑胺与万古霉素治疗老年耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的疗效,为其有效治疗提供临床依据。方法收集2009年12月-2012年12月46例MRSA肺炎老年患者的临床资料,按照治疗药物的不同分为利奈唑胺组(A组)21例和万古霉素组(B组)25例,比较两组患者的临床疗效,炎症指标的变化以及安全性,所有数据采用SPSS17.0进行统计分析。结果 MRSA肺炎老年患者治疗一疗程后有效率A组为85.71%、B组为72.00%;病原菌清除率A组为85.71%、B组为68.00%;两组患者治疗前血清中的C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平比较差异均无统计学意义;治疗一疗程后两组的CRP、TNF-α水平均较治疗前明显降低(P<0.05),且A组患者炎症指标水平下降幅度明显高于B组(P<0.05)。结论两种药物治疗老年MRSA肺炎的疗效差异性不大,但利奈唑胺整体优于万古霉素;万古霉素对患者的肾功能影响较大,考虑到老年患者的肾功能减退现状,建议老年患者使用利奈唑胺进行治疗。     

Descriptive analysis of patients with community-onset and hospital-onset methicillin-resistant Staphylococcus aureus infections.

Three hundred sixty-seven hospital- and community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections diagnosed in a Dallas-Fort Worth Metroplex community hospital are described. Differences in age, gender, ethnicity, and susceptibility to four antibiotics between the two groups of patients are explored.     

万古霉素与利奈唑胺治疗肺部感染的有效性及安全性评价

目的比较万古霉素与利奈唑胺治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染的疗效及安全性。方法选取2012年5月-2013年5月109例MRSA肺部感染患者为研究对象,将其分为万古霉素组73例及利奈唑胺组36例,万古霉素组予以万古霉素1.0g,每12h1次进行治疗,利奈唑胺组予以利奈唑胺0.6g,每12h1次进行治疗,观察两组患者治疗后的临床效果及安全性。结果治疗总有效率万古霉素组为76.71%、利奈唑胺组为61.11%,两组比较差异有统计学意义(P<0.05);而两组患者治疗后白细胞计数、C-反应蛋白、中性粒细胞比值、降钙素原及并发症发生率比较差异无统计学意义。结论对MRSA肺部感染患者,万古霉素与利奈唑胺敏感性均较高,总体疗效万古霉素略高,且安全性和耐受性较利奈唑胺略高。     

Light and length of stay in hospital.

A study was carried out to examine whether the time spent as an inpatient in hospital showed a seasonal dependence which could be attributed to differences in ambient lighting levels between summer and winter. It was found that the season of admission to hospital did not make any appreciable difference to how long patients took to recover before they were discharged.     

肿瘤专科医院耐甲氧西林金黄色葡萄球菌感染临床预防控制的研究

目的针对临床送检微生物培养结果,对耐甲氧西林金黄色葡萄球菌(MRSA)医院感染临床预防控制措施进行研究,探讨预防控制MRSA在医院传播的有效措施。方法将临床送检微生物培养监测到感染MRSA的患者采取院内传播预防控制措施:明确责任;强调宣教;重视督查,在该措施落实之前一季度医院收治的患者为对照组,在该措施落实1年后相同季度收治的患者为试验组。结果 MRSA隔离措施干预后比干预前医务人员知晓度有明显的提高(P<0.001),干预后比干预前持续改善手卫生执行效果明显(P<0.001);对照组与试验组MRSA住院床日数检出率分别为0.174‰和0.068‰,两组MRSA住院床日病例检出率差异有统计学意义(P<0.05)。结论该研究所采取的MRSA感染临床预防控制措施是有效可行的。     

Effect of pressure ulcers on length of hospital stay.

OBJECTIVE: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. DESIGN: Cross-sectional, observational study. SETTNG: Tertiary-care referral and teaching hospital in Australia. PATIENTS: Two thousand hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units. METHODS: Two thousand participants were randomly selected from 4,500 patients enrolled in a prospective survey conducted between October 2002 and January 2003. Quantile median robust regression was used to assess risk factors for excess length of hospital stay. RESULTS: Having a pressure ulcer resulted in a median excess length of stay of 4.31 days. Twenty other variables were statistically significant at the 5% level in the final model. CONCLUSIONS: Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis. However, our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers; existing estimates may overstate the true economic cost.     

Influence of length of stay on patient satisfaction with hospital care in Japan.

OBJECTIVE: The objective of this study was to identify specific patient satisfaction items related to overall satisfaction by different length of stay (LOS) for patients in Japanese hospital settings. METHODS: This cross-sectional study involved a participant sample, drawn from 77 voluntarily participating hospitals throughout Japan, of in-patients discharged to the community. Older patients and psychiatric, pediatric, obstetric and gynecologic patients were excluded. The 1050 respondents analyzed (response rate > or = 5l.1%) were divided into three groups based on their LOS: group 1, LOS < or = 1 week; group 2, LOS < or = 1 month; and group 3, LOS > 1 month. Using stepwise multiple regression analysis, we explored for each LOS group the relationship between overall patient satisfaction and satisfaction with 33 individual items, including three regarding perceived reputation of the hospital in question. RESULTS: Some unique satisfaction items for each group (e.g. 'skill of nursing care' in group 1, 'Recovery of physical health', 'skill of nursing care', and 'respect for patients opinions and feelings' in group 2, and 'relief from pain' and 'respect for patients' opinions and feelings' in group 3) were significantly associated with overall satisfaction. In all three groups, common items (e.g. 'recovery from distress and anxiety' and 'doctor's clinical competence') also related significantly to overall satisfaction. Two items pertaining to the hospital reputation dimension (e.g. 'family member's evaluation of the hospital' and 'hospital reputation among other patients') were also significant predictors of overall satisfaction in all three groups. CONCLUSION: The findings show that according to LOS, unique items could determine significantly the achievement of overall satisfaction, while some common predictors across all three LOS groupings also seemed to be indispensable for inpatient's assessment of hospital care. It was also confirmed in this study that a positive perception of hospital reputation might have an important role in patient satisfaction in Japan.     

A longitudinal analysis of methicillin-resistant Staphylococcus aureus in a Hong Kong teaching hospital.

OBJECTIVES: To review the incidence and trends of MRSA during a 12-year (1989-2000) period at a university teaching hospital and the relationship between strain distribution by antibiogram and molecular typing. DESIGN: Retrospective review of laboratory-based surveillance records on MRSA isolation and characterization of strains by antimicrobial susceptibility and PFGE. A patient episode was counted at the time when MRSA was first isolated. SETTING: A 1,350-bed university teaching hospital in Hong Kong. PATIENTS: Those with clinical isolates of MRSA. RESULTS: During 1989 to 2000, the hospital recorded 1,203,175 deaths and discharges (D&D) and encountered 5,707 patient episodes of new MRSA isolation. The overall incidence of patient episodes of MRSA was 0.47/100 D&D. In 1989, the incidence was 0.81/100 D&D and fell to a low of 0.33/100 D&D in 1995, but then rose to 0.50/100 D&D in 2000. Antibiogram and DNA typing identified 5 major types. PFGE type A constituted 68% (211/312) of isolates and was present throughout the 12-year period. PFGE type B constituted 13% (40/312) of isolates and was only present from 1995 to 2000. These isolates form a distinct clone and had unique antibiotic resistance profiles. CONCLUSIONS: The study showed the establishment of a dominant MRSA clone (PFGE type A group) in the intensive care, medical, and surgical units and the appearance of a new MRSA strain in 1995 (PFGE type B), which partly explained the rise in incidence of MRSA cases and a disproportionate rise in MRSA bacteremia from 1995 to 2000.     

The impact of malnutrition on morbidity,mortality, length of hospital stay and costs evaluated through a multivariate model analysis

Malnutrition has been identified as affecting patient outcome. The purpose of this study was to correlate the nutritional status of hospitalized patients with their morbidity, mortality, length of hospital stay and costs. The patients were nutritionally assessed within the first 72 h of hospital admission. The patients' charts were surveyed on the incidence of complications and mortality. Hospital costs were calculated based on economic tables used by insurance companies. Multivariate logistic regression analysis and the Cox regression model were used to identify possible confounding factors. A P<0.05 was considered statistically significant. The mean age was 50.6+/-17.3 years with 50.2% being male. The incidence of complications in the malnourished was 27.0% [Relative risk (RR)=1.60]. Mortality in the malnourished patients was 12.4% vs 4.7% in the well nourished (RR = 2.63). Malnourished patients stayed in the hospital for 16.7+/-24.5 days vs 10.1+/-11.7 days in the nourished. Hospital costs in malnourished patients were increased up to 308.9%. It was concluded that malnutrition, as analyzed by a multivariate logistic regression model, is an independent risk factor impacting on higher complications and increased mortality, length of hospital stay and costs.     

万古霉素治疗新生儿凝固酶阴性葡萄球菌感染的疗效及肾毒性观察

目的探究新生儿凝固酶阴性葡萄球菌感染采用万古霉素进行临床治疗的疗效以及该药物的肾毒性,为新生儿临床抗感染治疗提供依据。方法选择医院2013年3月-2016年3月期间收治的凝固酶阴性葡萄球菌感染的新生儿128例作为研究对象,根据选用抗菌药物的不同将患儿分为研究组和对照组,每组各64例;研究组患儿采用万古霉素联合广谱青霉素类进行治疗,对照组患儿仅采用广谱青霉素类进行治疗,对患儿治疗前及停药1周后的肾功能相关指标进行检查,对两组患儿采用不同方式进行治疗后的临床疗效及其肾毒性进行评价。结果研究组患儿在治疗后,治疗的总有效率为98.4%,对照组患儿的总有效率为89.1%,研究组患儿治疗的有效率高于对照组(P0.05);经过治疗后,研究组患儿尿常规检查异常5例,发生率为7.8%,尿素氮检查异常6例,发生率为9.3%,肌酐检查异常4例,发生率为6.2%,与对照组比较差异无统计学意义(P0.05);研究组经过治疗后,尿蛋白水平(0.053±0.017)g/L,尿α1-微量球蛋白水平(6.413±2.184)g/L,尿NAG水平(9.481±3.951)g/L,对照组患儿经过治疗后,尿蛋白水平(0.058±0.021)g/L,尿α1-微量球蛋白水平(6.621±3.244)g/L,尿NAG水平(10.116±4.034)g/L,两组比较差异无统计学意义(P0.05)。结论万古霉素对于新生儿凝固酶阴性葡萄球菌感染的治疗效果显著,并且对患儿肾毒性较小,因此合理的万古霉素药物剂量以及治疗方式可有效地控制新生儿凝固酶阴性葡萄球菌的感染情况,提高患儿治疗效果。     

An epidemiological survey of methicillin-resistant Staphylococcus aureus in a tertiary referral hospital

Over a 30-month period from July 1995 to December 1997, new detections of methicillin-resistant Staphylococcus aureus (MRSA) were prospectively studied in a tertiary referral hospital. The aims of the study were to determine the incidence of colonization of patients admitted to each of the hospital's 39 clinical units and ascertain where each patient had become colonized. Epidemiological information (time to detection, ward movement, admission to other hospitals, data on MRSA isolations in hospital wards) and phage typing were used by the hospital's infection control unit to make this determination. Routine containment procedures included cohorting, flagging and triclosan body washes. Surveillance cultures were collected infrequently. Patients known to be colonized with MRSA were excluded from orthopaedic and haematology wards. During the study period, 995 patients were found to be newly colonized. The incidence of colonization varied from nil to 72 per 1000 admissions, being highest in the main intensive care unit and in services which frequently used that unit. The incidence of colonization in elective orthopaedic surgery (< 1 per 1000) and haematology (3 per 1000) was very low. Determining the place where patients acquired MRSA was made difficult by the high frequency of endemic phage types and frequent patient transfer between wards. Epidemiological data suggested that the main intensive care unit and surgical wards nursing patients with colorectal, urological and vascular diseases were the places where most patients became colonized. MRSA was never acquired by patients nursed in wards which practised an exclusion policy towards patients known to be colonized with MRSA. Our data suggest that in tertiary referral hospitals, where MRSA is not only endemic but frequently imported from other hospitals, it is possible to establish areas where MRSA is never acquired.     

An application of lifetime models in estimation of expected length of stay of patients in hospital with complexity and age adjustment

Expected length of stay (ELOS) of patients in hospital is an important measure in hospital resource utilization management. Previous work has shown that estimation of ELOS is improved using complexity and age adjustment. These improved estimates have the potential to improve the accuracy of estimates of resource use. Recently other authors have applied the linear regression model to make complexity and age adjustments in the estimation of ELOS. However, these estimates using linear regression estimates are likely flawed on the basis that the assumptions regarding the distribution of data for the linear regression model are unjustifiable. The non-normal distributions of most hospital patient discharge data demand that an alternative method be described to provide accurate estimates of ELOS. The purpose of this paper is to describe an alternative method which uses lifetime models to initially estimate the expected length of stay. The paper then provides an approach to estimate the adjusted expected length of stay (AELOS) using several influencing factors by application of lifetime models. Depending on whether or not the proportional hazards assumption is appropriate for the data, the Cox proportional hazards model or the Kaplan-Meier adjustment is recommended.     

万古霉素治疗术后耐甲氧西林革兰阳性菌致颅内感染的疗效

目的 通过万古霉素不同给药方式治疗术后耐甲氧西林革兰阳性菌致颅内感染的比较,评价其疗效和安全性.方法 将颅脑术后耐甲氧西林革兰阳性菌致颅内感染患者72例,随机分为3组:A组静脉滴注万古霉素；B组鞘内给药万古霉素和地塞米松；C组按A、B组方法联合用药,汇总患者症状体征及脑脊液生化分析评价3种不同给药方式的疗效相关性.结果 A组总有效率79.2％显著低于B组100.0％、C组100.0％；治疗前、后颅内压A组为(253.1±33.2)、(134.5±27.8)mm H2O,B组为(260.1±25.5)、(116.5±27.8)mm H2O,C组为(260.1±25.5)、(102.7±22.3)mm H2O;治疗前、后血白细胞数A组为(27.8±5.8)、(8.8±3.3)×109/L,B组为(29.2±8.8)、(6.3±7.4)×109/L,C组为(28.5±4.4)、(6.2±6.3)×109/L,3组在颅内压、血白细胞数等方面依次减低,组间比较差异有统计学意义(P＜0.05)；而3组治疗前后脑脊液氯化物依次升高,A组为(88.2±2.3)、(118.4±3.3)mmol/L,B组为(89.3±3.1)、(125.7±4.5) mmol/L,C组为(84.7±7.3)、(128.5±6.5)mmol/L,差异均有统计学意义(P＜0.05)；组间的临床有效治疗时间依次缩短,C组时间最短；A组中有2例出现不良反应,其余两组未有出现.结论 万古霉素鞘内给药治疗耐甲氧西林革兰阳性菌致颅内感染效果显著,安全性高、不良反应较少.     

Economic burden associated with multi-resistant Gram-negative organisms compared with that for methicillin-resistant Staphylococcus aureus in a university teaching hospital

The aim of this study was to investigate the hospital costs of patients with multi-drug-resistant Gram-negative bacilli (MR-GNB) compared with those for patients with methicillin-resistant Staphylococcus aureus (MRSA), using the Austrian performance-related hospital financing system (LKF). The study was performed retrospectively at Vienna General Hospital, a 2,160-bed university teaching hospital, from January to June 2002. There were 99 patients in the MR-GNB group (median age 58 years) and 74 patients in the MRSA group (median age 60 years). More patients in the MR-GNB group (59 patients, 60%) were treated in the intensive care unit compared with patients in the MRSA group (25 patients, 34%) (P<0.01). The median hospital stay (42 and 37 days, respectively) and mortality (18 and nine deaths, respectively) of the two groups were similar. The total hospital cost for patients in the MR-GNB group was higher [4 915 712 LKF credit points (median: 34,180) equivalent to 2,605,327 pounds (median: 18,115 pounds )] than that for patients in the MRSA group [2,088,904 LKF credit points (median: 12,650) equivalent to 1, 093, 906 pounds (median: 6,624 pounds)] (P<0.01). This study is limited by being retrospective and having charge-based costings. However, it suggests that the hospital costs of patients with MR-GNB are substantial and may be greater than those of patients with MRSA.     

医院感染对肺癌患者住院费用与住院日的影响研究

目的探讨肺癌患者医院感染病原菌种类及对患者住院费用和住院日的影响。方法回顾性分析肿瘤内科2007年1月-2013年6月收治的肺癌患者300例,其中50例发生医院感染为观察组,在其余未发生医院感染的患者中匹配选择50例为对照组,比较两组患者住院费用和住院天数。结果观察组医院感染病原菌以革兰阴性菌为主占68.0%,其次为真菌占26.0%、、革兰阳性菌占6.0%;观察组肺癌患者住院费用为(27 366.5±5 132.47)元、住院时间为(26.5±3.55)d,对照组分别为(19 275.25±4 212.56)元、(19.5±2.75)d,两组比较差异有统计学意义(P<0.05),观察组费用高、住院时间长、呼吸系统感染多见,感染病原菌以革兰阴性菌和真菌为主。结论导致肺癌患者医院感染的病原菌以革兰阴性菌和真菌为主,发生医院感染将增加患者住院费用、延长住院时间,需临床工作高度重视。