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Excess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection

Published online by Cambridge University Press:  02 January 2015

Gregory A. Filice ,
John A. Nyman ,
Catherine Lexau ,
Christine H. Lees ,
Lindsay A. Bockstedt ,
Kathryn Como-Sabetti ,
Lindsey J. Lesher  and
Ruth Lynfield
Gregory A. Filice*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, Minnesota Infectious Disease Section, Medical Service, Veterans Affairs Medical Center, Minnesota
John A. Nyman
Affiliation:
Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis
Catherine Lexau
Affiliation:
Minnesota Department of Health, Saint Paul, Minnesota
Christine H. Lees
Affiliation:
Minnesota Department of Health, Saint Paul, Minnesota
Lindsay A. Bockstedt
Affiliation:
Division of Health Services Research and Policy, University of Minnesota School of Public Health, Minneapolis
Kathryn Como-Sabetti
Affiliation:
Minnesota Department of Health, Saint Paul, Minnesota
Lindsey J. Lesher
Affiliation:
Minnesota Department of Health, Saint Paul, Minnesota
Ruth Lynfield
Affiliation:
Minnesota Department of Health, Saint Paul, Minnesota
*
Infectious Disease Section (111F), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417 ([email protected])
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Abstract

Objective.

To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults.

Design.

Retrospective study of all cases of S. aureus infection.

Setting.

Department of Veterans Affairs hospital and associated clinics.

Patients.

There were 390 patients with MSSA infections and 335 patients with MRSA infections.

Methods.

We used medical records, accounting systems, and interviews to identify services rendered and costs for Minneapolis Veterans Affairs Medical Center patients with S. aureus infection with onset during the period from January 1, 2004, through June 30, 2006. We used regression analysis to adjust for patient characteristics.

Results.

Median 6-month unadjusted costs for patients infected with MRSA were $34,657, compared with $15,923 for patients infected with MSSA. Patients with MRSA infection had more comorbidities than patients with MSSA infection (mean Charlson index 4.3 vs 3.2; P < .001). For patients with Charlson indices of 3 or less, mean adjusted 6-month costs derived from multivariate analysis were $51,252 (95% CI, $46,041–$56,464) for MRSA infection and $30,158 (95% CI, $27,092–$33,225) for MSSA infection. For patients with Charlson indices of 4 or more, mean adjusted costs were $84,436 (95% CI, $79,843–$89,029) for MRSA infection and $59,245 (95% CI, $56,016–$62,473) for MSSA infection. Patients with MRSA infection were also more likely to die than were patients with MSSA infection (23.6% vs 11.5%; P < .001). MRSA infection was more likely to involve the lungs, bloodstream, and urinary tract, while MSSA infection was more likely to involve bones or joints; eyes, ears, nose, or throat; surgical sites; and skin or soft tissue (P < .001).

Conclusions.

Resistance to methicillin in S. aureus was independently associated with increased costs. Effective antimicrobial stewardship and infection prevention programs are needed to prevent these costly infections.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 365 - 373
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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