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目的调查重症住院患者医院感染特征,分析不同感染特征对医疗费用的影响。方法选取2012年6月—2015年10月在杭州市肿瘤医院重症监护室(ICU)接受治疗并发生医院感染的患者62例作为感染组,同期未发生医院感染的患者62例作为对照组,比较两组的医疗费用,调查感染组患者真菌感染和多重耐药菌感染情况,分析其对医疗费用的影响。结果发生医院感染以肺部感染最多,占70.97%;真菌感染占29.03%,11.29%为侵袭性真菌感染;检测到多重耐药菌占45.16%;病死率为11.29%。感染组的治疗费用、住院费用、诊断费用和药费均高于对照组(P<0.05);感染组中感染多重耐药菌患者的治疗费用、住院费用和药费均高于同组未感染多重耐药菌患者(P<0.05);感染真菌患者的治疗费用、住院费用和药费均高于同组未感染真菌患者(P<0.05)。结论 ICU内发生医院感染的患者,医疗费用明显高于未感染患者;尤其是多重耐药菌和真菌感染者治疗费用、住院费用和药费方面的医疗支出明显增加。
Objective To investigate the characteristics of nosocomial infection in critically inpatients and analyze the influence of different infection characteristics on medical expenses. Methods Sixty-two patients who were hospitalized in Intensive Care Unit (ICU) of Hangzhou Cancer Hospital from June 2012 to October 2015 were selected as the infected group and 62 patients without nosocomial infection during the same period as the control group. The two groups of medical expenses, the investigation of infection in patients with fungal infections and multi-resistant bacteria infection, analysis of its impact on medical costs. Results The most common infection was pulmonary infection in hospital, accounting for 70.97%. Fungal infection accounted for 29.03% and 11.29% for invasive fungal infection. Multi-drug resistant bacteria accounted for 45.16%. The case fatality rate was 11.29%. The cost of treatment, hospitalization, diagnosis and drug cost in infection group were higher than those in control group (P <0.05). The infection, hospitalization cost and drug cost in patients infected with multi-resistant bacteria were higher than those in control group (P <0.05). The treatment cost, hospitalization cost and drug cost of fungal infected patients were higher than those of uninfected patients (P <0.05). Conclusions Patients with nosocomial infections in the ICU have a significantly higher medical cost than those without nosocomial infections. In particular, the medical costs for treatment, hospitalization and medical expenses for multidrug-resistant and fungal infections are significantly increased.