Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences?

Abstract

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.

The Economic Burden of Head and Neck Cancer: A Systematic Literature Review

“…In the current review, 20 publications from 19 studies described costs attributable to symptoms and side effects arising directly from the various treatments for HNC [11, 13, 15, 16, 25, 32, 36, 39, 42, 45, 47, 49, 50, 54, 59, 60, 73, 75, 76, 94]. The most commonly reported costs for treatment-related complications were due to infection [15, 16, 39, 45, 49, 59, 73] and surgical reconstruction following tumor resection [11, 36, 60, 75, 94].…”

“…The most commonly reported costs for treatment-related complications were due to infection [15, 16, 39, 45, 49, 59, 73] and surgical reconstruction following tumor resection [11, 36, 60, 75, 94]. Expenses for several other treatment-emergent side effects were noted, including peripheral neuropathy [50], dermatologic adverse drug reactions, acute mucositis [13, 25, 47, 54], osteoradionecrosis [76], and deep vein thrombosis or pulmonary embolism [32].…”

Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes

“…This is significant, as patients with head and neck cancer who develop MRSA infection have been shown to have increased surgical morbidity and mortality. 12 Further research has implicated neoplasia as an independent risk factor for mortality from nosocomial S. aureus bacteraemia. 13 Health economy issues are also relevant given the high costs associated with hospital stay for oncology patients.…”

Prevalence of MRSA in elective day case pediatric ENT surgical patients

“…The average hospital stay was three times more prolonged and antibiotic costs increased by £2470 (US$3810/s2953) per patient because of MRSA [9]. In a retrospective review of postoperative infections of ENT surgical patients MRSA (the authors do not state if these were adult, pediatric or mixed), 0.83% who had not undergone preoperative MRSA screening were found to have MRSA wound infections [10].…”