Erişkin Genel Yoğun Bakım Ünitesindeki Sepsis Hastalarında Kaynaklarına Göre Maliyetlerinin Karşılaştırılması
Abstract
Amaç: Sepsis; dünya
üzerinde en sık karşılaşılan ve mortalite oranı en yüksek hastalıktır. Yıllık
ölüm nedenleri sıralamasında ilk sırada yer almaktadır. Maliyeti son derece
yüksektir ve her yıl yaklaşık %12 oranında artmaktadır. Sepsis tedavisinin
maliyeti, toplam sağlık harcamalarının önemli bir kısmını oluşturmaktadır.
Erken tanı, etken patojene yönelik erken antibiyotik başlanması tedavinin
başarısını etkileyen en önemli faktörlerdir. Biz bu çalışmamızda, yoğun
bakımdaki sepsis hastalarında kaynaklarına göre maliyet farklarını araştırmayı
amaçladık.
Gereç ve Yöntem: Ahi Evran
Üniversitesi Eğitim ve Araştırma Hastanesi Erişkin Genel Yoğun Bakım Ünitesinde
(YBÜ) 24 saatten uzun süreyle 01.01.2015-31.12.2015 tarihleri arasında yatan
sepsis hastalarının dosyaları retrospektif olarak incelendi. Hastaların
demografik verileri, etken patojenleri, yatış süreleri, yoğun bakım sonuçları,
kullandığı antibiyotikler, tetkik ücretleri, tedavi hizmeti ücretleri, yatak
ücretleri, ilaç ve sarf-malzeme ücretleri ayrı ayrı kaydedildi.
Bulgular: Dönem içinde
YBÜ’sinde yatan 670 hastanın 52’si (%7,8) sepsis tanısı ile yatmıştır. %51,9’u
(n=27) kadın ve %48,1’i (n=25) erkektir. Hastaların; yaşlarının 73,2±12,6 [74
(27–98)] olduğu bulunmuştur. %65,4’ü (n=34) 70 yaş ve üzerindedir. Saptanan en
sık etken patojen Acinetobacter Baumanni’dir [ (n=17) (%32,7)]. Sepsis kaynağı
olarak en sık %48,1(n=25) solunum sistemi saptanmıştır. Hastaların; yoğun bakım
yatış sürelerinin 13,7±14,3 [10,5 (2–97)], Apache 2 Skorlarının 23,9±7,0 [24
(9–39)], mortalite oranının %90,4 (n=47) olduğu bulunmuştur. Sepsis kaynakları
arasında; yaş, yoğun bakım yatış süresi, Apache 2 skoru, mortalite oranları ve
tüm maliyet değerleri yönünden istatistiksel olarak anlamlı bir fark olmadığı
bulunmuştur (p>0,05).
Sonuç: Sepsis; kaynağı ne olursa olsun
mortalitesi yüksek bir hastalıktır. Fatura toplamının ve ilaç toplam tutarının
önemli bir kısmını antibiyotik giderleri oluşturmaktadır.
Keywords
References
- Kaynaklar 1. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS data brief. 2011(62):1-8. Epub 2011/12/07. 2. Daniels R. Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective). J Antimicrob Chemoth. 2011;66:11-23. 3. Tsertsvadze A, Royle P, Seedat F, Cooper J, Crosby R, McCarthy N. Community-onset sepsis and its public health burden: a systematic review. Systematic reviews. 2016;5(1):81. Epub 2016/05/20. 4. Angus DC. The lingering consequences of sepsis: a hidden public health disaster? Jama. 2010;304(16):1833-4. Epub 2010/10/28.
- 5. Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (vol 41, pg 580, 2013). Crit Care Med. 2014;42(1):88. 6. Robson W, Nutbeam T, Daniels R. Sepsis: a need for prehospital intervention? Emergency medicine journal : EMJ. 2009;26(7):535-8. Epub 2009/06/24. 7. Çopuroğlu E, Dikmen Y, Demirkıran O, Utku T, Ürkmez S. Protokole Dayalı Tedavinin Ağır Sepsis Mortalitesi Üzerine Etkisi. Journal of the Turkish Society Intensive Care. J Turk Soc Intens Care. 2011;9:90-8. 8. Frost R, Newsham H, Parmar S, Gonzalez-Ruiz A. Impact of delayed antimicrobial therapy in septic ITU patients. Critical Care Med. 2010;14(Suppl 2):P20-P. 9. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367-74. Epub 2009/12/26. 10. Talmor D, Greenberg D, Howell MD, Lisbon A, Novack V, Shapiro N. The costs and cost-effectiveness of an integrated sepsis treatment protocol. Crit Care Med. 2008;36(4):1168-74. 11. Chalupka AN, Talmor D. The Economics of Sepsis. Crit Care Clin. 2012;28(1):57-+. 12. Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E, et al. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care. 2013;28(4):526-8. 13. Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care Med. 2005;9(6):R764-70. Epub 2005/12/17. 14. Aygencel G, Türkoğlu M. Bir Dahili Yoğun Bakım Ünitesindeki Terminal Dönem Hastaların Genel Özellikleri ve Maliyetleri. Turkish Journal of Medical & Surgical Intensive Care Medicine/Dahili ve Cerrahi Bilimler Yogun Bakim Dergisi. Yoğun Bakım Derg. 2014;5(1). 15. Shapiro NI, Howell MD, Talmor D, Lahey D, Ngo L, Buras J, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34(4):1025-32. Epub 2006/02/18. 16. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10. 17. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert review of anti-infective therapy. 2012;10(6):701-6. Epub 2012/06/28. 18. ERTÜRK A, ÇİÇEK AÇ, KÖKSAL E, KÖKSAL ZŞ, ÖZYURT S. Yoğun bakim ünitesinde yatan hastalarin çeşitli klinik örneklerinden izole edilen mikroorganizmalar ve antibiyotik duyarliliklari. Ankem Derg. 2012;26(1):1-9. 19. Leblebicioglu H, Erben N, Rosenthal VD, Atasay B, Erbay A, Unal S, et al. International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012. Ann Clin Microb Anti. 2014;13. 20. Bates DW, Yu T, Black E, Sands KE, Schwartz JS, Hibberd PL, et al. Resource utilization among patients with sepsis syndrome. Infect Cont Hosp Ep. 2003;24(1):62-70. 21. Eber MR, Laxminarayan R, Perencevich EN, Malani A. Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia. Arch Intern Med. 2010;170(4):347-53. 22. Vandijck DM, Depaemelaere M, Labeau SO, Depuydt PO, Annemans L, Buyle FM, et al. Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection. Int J Antimicrob Ag. 2008;31(2):161-5. 23. Ben-David D, Novikov I, Mermel LA. Are There Differences in Hospital Cost Between Patients With Nosocomial Methicillin-Resistant Staphylococcus aureus Bloodstream Infection and Those With Methicillin-Susceptible S-aureus Bloodstream Infection? Infect Cont Hosp Ep. 2009;30(5):453-60. 24. Butler AM, Olsen MA, Merz LR, Guth RM, Woeltje KF, Camins BC, et al. Attributable Costs of Enterococcal Bloodstream Infections in a Nonsurgical Hospital Cohort. Infect Cont Hosp Ep. 2010;31(1):28-35. 25. Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ. Resmi Gazete2015. p. http://www.resmigazete.gov.tr/main.aspx?home=http://www.resmigazete.gov.tr/eskiler/2015/10/20151030.htm&main=http://www.resmigazete.gov.tr/eskiler/2015/10/.htm. 26. Necmettin Erbakan Ü. Yoğun Bakımcılar Açısından Bütçe Uygulama Talimatı ve Kısıtlı Antibiyotik Kullanımı: Hedefler, Beklentiler, Sonuçlar ve Öneriler. Ankem Derg. 2006;20(1):55-60.
Abstract
INTRODUCTION: Sepsis is the commonest disease with the highest mortality rate in the World. It is the leading cause of death annually. It has a high cost and increases by %12 each year. The cost of treatment of sepsis occupies majority of health expenditure. Early diagnosis, and immediate effective treatment against the susceptible pathogen are the major determinants of success in treatment.
In the current study we aimed to determine the difference in the cost of treatment of sepsis according to etiological pathogen types in patients treated at intensive care unit (ICU).
METHODS: Patients hospitalized in ICU for more than 24 hours at Ahi Evran University Training and Research Hospital between 01.01.2015 – 31.12.2015 diagnosed as sepsis were included in the study. Medical records were retrospectively analyzed. Demographic data, pathogen type, length of stay in hospital, results of ICU stay, antibiotics used, laboratory test costs, treatment maintenance costs, hospitalization costs, drug and medical assets costs were assessed.
RESULTS: 670 patients were hospitalized at ICU in the given time period and 52 (7.8%) of them were diagnosed as sepsis. 51.9% (n=27) of the patients were female and 48.1% (n=25) of the patients were male. Mean age of the patients with sepsis was 73.2±12.6 [74(27-98)]. 65.4% (n-34) of the patients were older than 70 years. The most common pathogen isolated was Acinetobacter Baumanni [(n=1, 32.7%)] (Table 1). Respiratory system was the leading source of sepsis.[48.1%, n=25)]. The length of stay at ICU was 13.7±14.3 [10.5(2-97)], Apache scores were between 9 and 39 with a mean of 24 (23.9±7.0) and the mortality rate was 90.4% (n=47). No statistically significant difference was determined between the etiologic pathogen type and age, length of stay at ICU, Apache II score, mortality rate and total treatment cost.(p>0.05) (Table 2, Table 3)
DISCUSSION AND CONCLUSION: Sepsis has a wery high mortality rate independent from the etiological pathogen. Majority of the treatment cost and drug costs are constituted by the antibiotics.
Keywords
References
- Kaynaklar 1. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS data brief. 2011(62):1-8. Epub 2011/12/07. 2. Daniels R. Surviving the first hours in sepsis: getting the basics right (an intensivist's perspective). J Antimicrob Chemoth. 2011;66:11-23. 3. Tsertsvadze A, Royle P, Seedat F, Cooper J, Crosby R, McCarthy N. Community-onset sepsis and its public health burden: a systematic review. Systematic reviews. 2016;5(1):81. Epub 2016/05/20. 4. Angus DC. The lingering consequences of sepsis: a hidden public health disaster? Jama. 2010;304(16):1833-4. Epub 2010/10/28.
- 5. Dellinger RP, Levy MM, Rhodes A. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (vol 41, pg 580, 2013). Crit Care Med. 2014;42(1):88. 6. Robson W, Nutbeam T, Daniels R. Sepsis: a need for prehospital intervention? Emergency medicine journal : EMJ. 2009;26(7):535-8. Epub 2009/06/24. 7. Çopuroğlu E, Dikmen Y, Demirkıran O, Utku T, Ürkmez S. Protokole Dayalı Tedavinin Ağır Sepsis Mortalitesi Üzerine Etkisi. Journal of the Turkish Society Intensive Care. J Turk Soc Intens Care. 2011;9:90-8. 8. Frost R, Newsham H, Parmar S, Gonzalez-Ruiz A. Impact of delayed antimicrobial therapy in septic ITU patients. Critical Care Med. 2010;14(Suppl 2):P20-P. 9. Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367-74. Epub 2009/12/26. 10. Talmor D, Greenberg D, Howell MD, Lisbon A, Novack V, Shapiro N. The costs and cost-effectiveness of an integrated sepsis treatment protocol. Crit Care Med. 2008;36(4):1168-74. 11. Chalupka AN, Talmor D. The Economics of Sepsis. Crit Care Clin. 2012;28(1):57-+. 12. Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E, et al. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care. 2013;28(4):526-8. 13. Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care Med. 2005;9(6):R764-70. Epub 2005/12/17. 14. Aygencel G, Türkoğlu M. Bir Dahili Yoğun Bakım Ünitesindeki Terminal Dönem Hastaların Genel Özellikleri ve Maliyetleri. Turkish Journal of Medical & Surgical Intensive Care Medicine/Dahili ve Cerrahi Bilimler Yogun Bakim Dergisi. Yoğun Bakım Derg. 2014;5(1). 15. Shapiro NI, Howell MD, Talmor D, Lahey D, Ngo L, Buras J, et al. Implementation and outcomes of the Multiple Urgent Sepsis Therapies (MUST) protocol. Crit Care Med. 2006;34(4):1025-32. Epub 2006/02/18. 16. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303-10. 17. Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert review of anti-infective therapy. 2012;10(6):701-6. Epub 2012/06/28. 18. ERTÜRK A, ÇİÇEK AÇ, KÖKSAL E, KÖKSAL ZŞ, ÖZYURT S. Yoğun bakim ünitesinde yatan hastalarin çeşitli klinik örneklerinden izole edilen mikroorganizmalar ve antibiyotik duyarliliklari. Ankem Derg. 2012;26(1):1-9. 19. Leblebicioglu H, Erben N, Rosenthal VD, Atasay B, Erbay A, Unal S, et al. International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012. Ann Clin Microb Anti. 2014;13. 20. Bates DW, Yu T, Black E, Sands KE, Schwartz JS, Hibberd PL, et al. Resource utilization among patients with sepsis syndrome. Infect Cont Hosp Ep. 2003;24(1):62-70. 21. Eber MR, Laxminarayan R, Perencevich EN, Malani A. Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia. Arch Intern Med. 2010;170(4):347-53. 22. Vandijck DM, Depaemelaere M, Labeau SO, Depuydt PO, Annemans L, Buyle FM, et al. Daily cost of antimicrobial therapy in patients with Intensive Care Unit-acquired, laboratory-confirmed bloodstream infection. Int J Antimicrob Ag. 2008;31(2):161-5. 23. Ben-David D, Novikov I, Mermel LA. Are There Differences in Hospital Cost Between Patients With Nosocomial Methicillin-Resistant Staphylococcus aureus Bloodstream Infection and Those With Methicillin-Susceptible S-aureus Bloodstream Infection? Infect Cont Hosp Ep. 2009;30(5):453-60. 24. Butler AM, Olsen MA, Merz LR, Guth RM, Woeltje KF, Camins BC, et al. Attributable Costs of Enterococcal Bloodstream Infections in a Nonsurgical Hospital Cohort. Infect Cont Hosp Ep. 2010;31(1):28-35. 25. Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinde Değişiklik Yapılmasına Dair Tebliğ. Resmi Gazete2015. p. http://www.resmigazete.gov.tr/main.aspx?home=http://www.resmigazete.gov.tr/eskiler/2015/10/20151030.htm&main=http://www.resmigazete.gov.tr/eskiler/2015/10/.htm. 26. Necmettin Erbakan Ü. Yoğun Bakımcılar Açısından Bütçe Uygulama Talimatı ve Kısıtlı Antibiyotik Kullanımı: Hedefler, Beklentiler, Sonuçlar ve Öneriler. Ankem Derg. 2006;20(1):55-60.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Publication Date | August 15, 2018 |
| Published in Issue | Year 2018 Volume: 2 Issue: 2 |
Cite
Ahi Evran Medical Journal is indexed in ULAKBIM TR Index, Turkish Medline, DOAJ, Index Copernicus, EBSCO and Turkey Citation Index. Ahi Evran Medical Journal is periodical scientific publication. Can not be cited without reference. Responsibility of the articles belong to the authors.
