Clinical and economic impact of methicillin-resistant Staphylococcus aureus: a multicentre study in China

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious threat to global health.In China, the proportion of S. aureus isolates that were MRSA was 44.6% in 2014. The clinical and economic impact of MRSA in China remains largely uninvestigated. This study aims to compare the differences in hospital costs, length of hospital stay, and hospital mortality rate between MRSA and methicillin-susceptible S. aureus (MSSA) colonization or infection and between MRSA cases and those without an S. aureus infection. A retrospective and multicentre study was conducted in four tertiary hospitals in China between 2013 and 2015. Inpatient characteristics and hospital costs were collected from electronic medical records. We conducted propensity score matching (PSM) to eliminate selection bias by balancing the potential confounding variables between the two groups. The main indicators included hospital costs, length of hospital stay, and hospital mortality rate. A total of 1,335 inpatients with MRSA, 1,397 with MSSA, and 33,606 without an S. aureus infection were included. PSM obtained 954 and 1,313 pairs between the MRSA and MSSA groups and between the MRSA and S. aureus-free groups, respectively. After PSM, MRSA colonization or infection is associated with an increased total hospital cost ranging from $3,220 to $9,606, an excess length of hospital stay of 6 days-14 days, and an attributable hospital mortality rate of 0-3.58%. Between the MRSA and MSSA groups, MRSA colonization or infection was significantly associated with a higher total hospital cost and longer length of hospital stay among survivors but not among non-survivors; however, there were no differences in the hospital mortality rate between these two groups. Between the MRSA and the S. aureus-free groups, MRSA colonization or infection was significantly associated with an increased total hospital cost, a prolonged length of hospital stay and a higher hospital mortality rate among both survivors and non-survivors. It is critical to quantify the clinical and economic impact of MRSA to justify resource allocation for the development of strategies to improve clinical outcomes and to reduce the economic burden.Staphylococcus aureus is an important gram-positive bacterium in both community-and health-care-associated infections and can be resistant or susceptible to the usual antibiotics used to treat it (oxacillin or cefoxitin), namely, methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus (MSSA), respectively 1,2 . MRSA has become a serious threat to global health and is responsible for a range of infections, from skin and wound infections to pneumonia and bloodstream infections. It is commonly associated with significant morbidity, hospital mortality, length of stay and economic burden 1 . In all World Health Organization (WHO) regions, the overall proportion of S. aureus isolates that were MRSA exceeded 20% and even exceeded 80% in some reports 3 . In China, there was a marked decrease in the proportion of MRSA from 69% in 2005 to 44.6...

Clinical and Economic Burden of Carbapenem-Resistant Infection or Colonization Caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii: A Multicenter Study in China

“…In this study, the main indicators included economic costs, LOS, and in-hospital mortality. We performed 1000 iterations of Monte Carlo simulations to calculate the 95% uncertainty interval for each indicator with normal distribution using SAS [ 35 ]. We compared the main indicators between CRKP and CSKP group, between CRPA and CSPA group, between CRAB and CSAB group using t test and χ 2 test for quantitative and qualitative variables, respectively.…”

Staphylococcus aureus Host Tropism and Its Implications for Murine Infection Models

“…The emergence and continuing spread of multi-resistant S. aureus strains, such as methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA), complicate the treatment of staphylococcal infections and cause a significant economic burden. For example, a multicenter study in China showed an average increase in hospital costs of 3182 USD to 6533 USD for MRSA patients as compared to methicillin-sensitive S. aureus (MSSA) patients [ 9 ]. Coupled to the fact that even reserve antibiotics fail to successfully treat severe S. aureus infections, it is not surprising that the WHO lists S. aureus as one of the major health threats in a so-called “post-antibiotic era” [ 10 ].…”

Detection of Methicillin Susceptible and Resistant Staphylococcus aureus Nasal Carriage and Its Antibiotic Sensitivity among Basic and Clinical Years Medical Students

“…Staphylococcus aureus ( S. aureus ) is considered one of the most common commensal bacteria that is usually found in the anterior nares of healthy individuals, but it is also a major pathogen that has been associated with serious community and nosocomial acquired infections, such as skin and soft tissue infections, pneumonia and bloodstream infections, which are associated with increased hospital mortality and morbidity [ 1 , 2 ]. The ability to develop resistance to various classes of antibiotics has brought more clinical attention to S. aureus .…”

“…Soon after the introduction of methicillin, resistance emerged in certain strains of S. aureus, and these strains became famously described as methicillin resistant Staphylococcus aureus (MRSA), which was first isolated in the UK in the early 1960s [ 3 ]. Since then, the prevalence of MRSA has increased and it has been found that MRSA proportion constituted between 20% and 80% of all S. aureus isolates in different countries [ 2 ].…”

“…In addition, MRSA usually shows resistance to a wide range of other commonly prescribed anti-staphylococcal antibiotics, which limits therapeutic options, making it necessary to use specialized antibiotics such as glycopeptides and linezolid to treat MRSA associated infections [ 6 ]. This emerging resistance has led to increased mortality and morbidity rates, length of hospital stays and costs of treatment [ 2 ].…”