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The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges

Published online by Cambridge University Press:  21 June 2016

Sara E. Cosgrove ,
Youlin Qi ,
Keith S. Kaye ,
Stephan Harbarth ,
Adolf W. Karchmer  and
Yehuda Carmeli
Sara E. Cosgrove*
Affiliation:
Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland
Youlin Qi
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, andHarvard Medical School, Boston, Massachusetts
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Stephan Harbarth
Affiliation:
Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
Adolf W. Karchmer
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, andHarvard Medical School, Boston, Massachusetts
Yehuda Carmeli
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, andHarvard Medical School, Boston, Massachusetts Division of Infectious Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
*
Osler 425, The Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287.[email protected]
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Abstract

Objective:

To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.

Design:

A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.

Setting:

A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.

Patients:

Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.

Results:

Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.

Conclusion:

Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 166 - 174
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Carmeli, Y, Troillet, N, Karchmer, AW, Samore, MH. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159:1127–1132.Google Scholar
2.Cosgrove, SE, Kaye, KS, Eliopoulous, GM, Carmeli, Y. Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species. Arch Intern Med 2001;162:185–190.CrossRefGoogle Scholar
3.Song, X, Srinivasan, A, Plaut, D, Perl, TM. Effect of nosocomial vancomycin-resistant enterococcal bacteremia on mortality, length of stay, and costs. Infect Control Hosp Epidemiol 2003;24:238–241.Google Scholar
4.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
5.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.CrossRefGoogle Scholar
6.Cluff, LE, Reynolds, RC, Page, DL, Breckenridge, JL. Staphylococcal bacteremia and altered host resistance. Ann Intern Med 1968;69:859–873.CrossRefGoogle ScholarPubMed
7.Julander, I. Unfavourable prognostic factors in Staphylococcus aureus septicemia and endocarditis. Scand J Infect Dis 1985;17:179–187.CrossRefGoogle ScholarPubMed
8.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.Google Scholar
9.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality related to methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2002;36:53–59.Google Scholar
10.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.CrossRefGoogle ScholarPubMed
11.Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99–104.CrossRefGoogle ScholarPubMed
12.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, ed. 5. Villanova, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M7-A5.Google Scholar
13.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;51 (RR-10):1–29.Google ScholarPubMed
14.McCabe, W, Jackson, G. Gram-negative bacteremia. Arch Intern Med 1962;110:847–855.Google Scholar
15.Roghmann, MC. Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia. Arch Intern Med 2000;160:1001–1004.Google Scholar
16.Lodise, TP, McKinnon, PS, Swiderski, L, Rybak, MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis 2003;36:1418–1423.CrossRefGoogle ScholarPubMed
17.Gonzalez, C, Rubio, M, Romero-Vivas, J, Gonzalez, M, Picazo, JJ. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 1999;29:1171–1177.CrossRefGoogle ScholarPubMed
18.Chang, FY, MacDonald, BB, Peacock, JE Jr, et al.A prospective multi-center study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance. Medicine (Baltimore) 2003;82:322–332.CrossRefGoogle Scholar
19.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182–189.Google Scholar
20.Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2008;36:1433–1437.Google Scholar