X Liu1, D Cui2, H Li2, Q Wang2, Z Mao2, L Fang3, N Ren4, J Sun5. 1. School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China; School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. 2. School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China. 3. Department of Infection Management, Department of Logistics, The Third People's Hospital of Hubei Province, Wuhan, China. 4. Department of Medical Care, People's Hospital, Hubei University of Medicine, Shiyan, China. 5. School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. Electronic address: sunjing@sph.pumc.edu.cn.
Abstract
BACKGROUND: Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the biggest global public health challenges, and overlap widely. These infections cause significant morbidity and mortality, put pressure on health systems, and incur rising direct and indirect costs. AIM: This study analysed the direct medical burden attributable to AMR-HAIs in Chinese public tertiary hospitals, and aimed to inform both the medical regulators and hospital managers for better control of HAIs and containment of AMR. METHODS: The propensity score matching method (γ= 0.25σ, nearest neighbor 1:1 matching) was applied to conduct a retrospective cohort study in five public tertiary hospitals in the Hubei province of China during 2013-2015. Descriptive analysis, Pearson's chi-squared test, Mann-Whitney U-test, Wilcoxon signed-rank test and paired/independent Z/T test were conducted. The statistically significant level was set at P<0.05. FINDINGS: From 2013 to 2015 overall, the additional total medical expenditure per HAI-AMR inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-AMR inpatient was 41 days compared with that of the non-HAIs (P<0.001). CONCLUSIONS: In combination with AMR, HAIs caused significant additional medical expenses and affected the turnover rate of hospital beds. Most of the increased medical costs fell to patients and their families. These findings call for more effective control of HAIs and containment of AMR. A national study is needed to estimate the medical, social and economic burden of HAIs in combination with AMR.
BACKGROUND: Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the biggest global public health challenges, and overlap widely. These infections cause significant morbidity and mortality, put pressure on health systems, and incur rising direct and indirect costs. AIM: This study analysed the direct medical burden attributable to AMR-HAIs in Chinese public tertiary hospitals, and aimed to inform both the medical regulators and hospital managers for better control of HAIs and containment of AMR. METHODS: The propensity score matching method (γ= 0.25σ, nearest neighbor 1:1 matching) was applied to conduct a retrospective cohort study in five public tertiary hospitals in the Hubei province of China during 2013-2015. Descriptive analysis, Pearson's chi-squared test, Mann-Whitney U-test, Wilcoxon signed-rank test and paired/independent Z/T test were conducted. The statistically significant level was set at P<0.05. FINDINGS: From 2013 to 2015 overall, the additional total medical expenditure per HAI-AMR inpatient was US$15,557.25 compared with that of the non-HAIs, and the additional length of per hospital stay of the HAI-AMR inpatient was 41 days compared with that of the non-HAIs (P<0.001). CONCLUSIONS: In combination with AMR, HAIs caused significant additional medical expenses and affected the turnover rate of hospital beds. Most of the increased medical costs fell to patients and their families. These findings call for more effective control of HAIs and containment of AMR. A national study is needed to estimate the medical, social and economic burden of HAIs in combination with AMR.