| Objective:Study a tertiary general hospital in escherichia.coli and klebsiella pneumonia hospital-acquired bloodstream infections caused by bacteria in the clinical features and their differences in the direct economic burden for clinicians timely targeted prevention measures,reduce the morbidity and mortality of hospital-acquired bloodstream infections,shorten the length of hospital stay,reduce patient direct economic burden,and provide a scientific basis.Methods:Collect a tertiary general hospital in January 2015-December 2019,included in the standard of hospital acquired bacteria escherichia.coli and klebsiella pneumonia in patients with bloodstream infections and the control group patients as the research object,the matching principle is 1:1,the ratio of standard is the same age 5 years of age,gender and discharged the first diagnosis(the main hospital cure diseases),the same name as the operation.Among them,58 patients were infected with hospital-acquired escherichia coli and 36 with hospital-acquired klebsiella pneumoniae.1.Hospital-acquired bloodstream infections in escherichia.coli and hospital acquired pneumonia klebsiella bacteria differences:the clinical features of bloodstream infections by retrospective investigation and study,comparison of hospital-acquired bloodstream infections in escherichia.coli and hospital-acquired pneumonia klebsiella bacteria bloodstream infections in the department of seasonal distribution,infection,inflammation indexes such as the change of the differences.The risk factors of hospital-acquired escherichia coli bloodstream infection and hospital-acquired klebsiella pneumoniae bloodstream infection were analyzed by case-control study,and the risk factors with statistically significant differences in univariate analysis were included in multi-factor logistic regression analysis to compare the differences in independent risk factors.2.Hospital-acquired escherichia coli and klebsiella pneumonia bacteria bloodstream infections of direct economic burden difference:by retrospective investigation a tertiary general hospital in January 2015-December 2019,included in the standard of hospital acquired bacteria escherichia coli and klebsiella pneumonia patients and control group in patients with bloodstream infections,length of hospital stay,hospital expenses by case-control study method,the matching principle is 1:1,the ratio of the standard is the same age 5 years of age,gender and discharged the first diagnosis(the main hospital cure diseases),the same operation name and evaluate patients with hospital-acquired bloodstream infections that increase of direct economic burden.The hospital stay and hospital expenses of patients with hospital-acquired escherichia coli and klebsiella pneumoniae bloodstream infection were compared,and the differences in the direct financial burden of patients with hospital-acquired bloodstream infection and the direct financial burden of patients with hospital-acquired bloodstream infection between different departments were evaluated.Results:1.Differences in clinical characteristics between hospital-acquired escherichia coli bloodstream infection and hospital-acquired klebsiella pneumoniae bloodstream infection:the detection rates of hospital-acquired escherichia coli and hospital-acquired klebsiella pneumoniae bloodstream infection were 1.5%and 0.93%,respectively,with bacteremia as the main part,accounting for 89.66%and 77.78%,respectively.The proportion of women in the former group was higher(86.21%),and the age group was mainly from 50 to 60 years old.The latter had a higher proportion of males(61.11%),and their ages ranged from 50 to 70 years old.The mortality rate of patients with acquired bloodstream infection of escherichia coli hospital was lower than that of patients with acquired bloodstream infection of klebsiella pneumoniae hospital,which was 1.72%and 16.67%,respectively.The incidence of hospital-acquired escherichia coli infection and hospital-acquired klebsiella pneumoniae infection was the highest in the third quarter,accounting for 2.79%and 1.26%,respectively,and the lowest in the first quarter,accounting for 0.69%and 0.52%,respectively.Patients with escherichia coli infection were mainly distributed in department of gynaecology(48.28%)and department of neurology(20.69%),while klebsiella pneumoniae was mainly distributed in ICU(30.56%)and department of neurology(22.22%).The proportion of c-reactive protein increased was 77.59%and 97.22%,and the proportion of leukocyte increased was 31.03%and 44.44%,respectively.The results of multi-factor Logistic regression analysis showed that the independent risk factor of patients with hospital acquired bloodstream infection with escherichia coli was low level of prealbumin(P<0.05).2.The direct economic burden difference between hospital-acquired escherichia coli bloodstream infection and hospital-acquired klebsiella pneumoniae bloodstream infection:the median total hospital stay of patients in the hospital-acquired infection group and the non-infected group was 13 days and 7 days,respectively,with a median difference of 6 days.The median total cost was 19,860 yuan and 10,473 yuan,respectively,with a difference of 9,387 yuan.The largest difference was 3,038 yuan for western medicine.Hospital-acquired bloodstream infections in Escherichia.coli patients with hospital acquired pneumonia klebsiella bacteria in patients with bloodstream infections median total cost is 17974 yuan and 31911.5 yuan respectively,median value of 13937.5 yuan,other expenses project differences were statistically significant,difference in cost project is the largest XiYaoFei,is 2396 yuan,the difference had statistical significance(P<0.05).The total hospitalization expenses of spinal surgery and neurosurgery patients accounted for the first two,with the median of 111,999 yuan and 107,176 yuan,respectively.The longest hospital stay was in thoracic surgery,with a median of 29 days,with obstetric inpatients having the lowest cost and length of stay.Conclusions:1.Hospital-acquired escherichia coli bloodstream infection was mainly distributed in the department of gynaecology(48.28%),and hospital-acquired klebsiella pneumoniae blood influenza was mainly distributed in the ICU(30.56%).Low levels of prealbumin are independent risk factors for hospital-acquired bloodstream infection with escherichia coli.When infection occurs,c-reactive protein level is more sensitive than leukocyte index,and abnormalities can occur earlier.2.The direct economic burden of patients with hospital-acquired bloodstream infection increased significantly,the length of stay increased by 6 days,and the total cost of hospitalization increased by 9387 yuan,of which the drug cost increased the most(3038 yuan).The direct economic burden of hospital-acquired klebsiella pneumoniae infection was greater than that of hospital-acquired escherichia coli infection,and the total cost difference was 13937.5 yuan,of which the drug cost difference was the largest(2396 yuan). |
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