Cost of bacteraemia caused by methicillin-resistant vs. methicillin-susceptible Staphylococcus aureus in Spain: a retrospective cohort study

Abstract

The aim of this study was to determine the impact on healthcare resource utilization and associated costs of bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA) vs. methicillin-susceptible S. aureus (MSSA) strains in Spain. An observational, retrospective, cohort multicentre study was conducted during 2005. The target population comprised Spanish patients with S. aureus bacteraemia (five and ten cases per hospital for resistant and susceptible strains, respectively). The resources used were obtained from the hospital patient records. The unit costs were obtained from the participating hospitals and from Spanish databases; the costs of a bacteraemic episode were estimated from resource utilization results and expressed in euros (euro). Univariate sensitivity analyses were performed. The clinical records of 366 valid patients with S. aureus bacteraemia (121 MRSA and 245 MSSA) from 27 Spanish hospitals were reviewed. Resource use per bacteraemic episode was higher for MRSA cases than for MSSA cases, with longer antibiotic treatment (3.1 additional days) and greater length of hospital stay (LOS) (2.2 additional days), more diagnostic tests, and higher rates of admission to the intensive-care unit (ICU) (7.6%). As a consequence, a higher cost per episode was incurred, with an additional euro1205 in episodes of MRSA infections (1.12-fold increase). The main drivers of the cost difference were the higher rates of ICU admission and hospital re-admission and increased LOS. The analysis confirmed that there were additional costs due to resistant strains, ranging from euro293 to euro5188. Overall, MRSA was associated with higher costs in bacteraemic patients, and this was attributable mainly to the greater rate of ICU admissions and increased LOS.

Impacto económico de la resistencia a meticilina en pacientes con bacteriemia por Staphylococcus aureus en hospitales de Bogotá

“…El impacto clínico en la mortalidad y la morbilidad de la infección causada por microorganismos resistentes en pacientes gravemente enfermos (9), va de la mano con el incremento en los costos de la atención y, probablemente, está asociado a los factores que permiten una mayor supervivencia; en este contexto, los costos más altos se generan por la atención en la unidad de cuidados intensivos y por el consumo de medicamentos e insumos, entre ellos los antibióticos (razón de medianas: En un estudio español se comprobó en los pacientes con SARM una mayor utilización de antibióticos, una estancia más prolongada, más utilización de pruebas diagnósticas y mayores tasas de ingreso a la unidad de cuidados intensivos (20). En otro estudio en los Estados Unidos se encontraron diferencias en el costo medio, el costo de la atención hospitalaria posterior a la bacteriemia y durante la estancia en el hospital, siendo mayores en el grupo de pacientes con bacteriemia por SARM, diferencias que, sin embargo, se desvanecieron al ajustar los valores por medio del análisis multivariado o análisis de propensión (30).…”

“…Hay reportes de incrementos entre 1,3 y 2 veces en los costos de atención cuando se comparan pacientes infectados por S. aureus resistente a la meticilina con pacientes con S. aureus sensible a dicho medicamento (18). En la literatura científica se reporta una duplicación del costo promedio del tratamiento para pacientes en hemodiálisis con bacteriemia por el germen resistente (€ 10.573 Vs. € 24.931) (19) y otros estudios han llegado a estimar un costo promedio de hasta € 11.044 por episodio (20).…”

“…Se cree que los costos de la infección por SARM son elevados con base en los estudios internacionales (16,19,20), pero no se cuenta con información local sobre su impacto en los recursos del sector de la salud. En el presente estudio se hizo una aproximación a la relación entre la resistencia de S. aureus a la meticilina y el costo de la atención en un grupo de pacientes atendido en unidades de cuidados intensivos de Bogotá, en el marco de un estudio multicéntrico de cohortes.…”

Controlled Multicenter Evaluation of a Bacteriophage-Based Method for Rapid Detection of Staphylococcus aureus in Positive Blood Cultures

“…Because approximately 30% of S. aureus isolates in U.S. hospitals are methicillin resistant, the most common antimicrobial used for presumptive S. aureus infection is vancomycin. Multiple studies have suggested that patients who have MRSA bacteremia have a longer length of stay in the hospital than those with MSSA bacteremia, resulting in higher hospital costs (3,(15)(16)(17)(18) and higher mortality as a result of inappropriate initial antibiotics (3).…”

Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

“…Methicillin-resistant S. aureus (MRSA) has caused an increasing proportion of intensive care unit (ICU)-acquired S. aureus infections in the United States over the last twenty years. Compared with methicillin-sensitive S. aureus (MSSA), MRSA infections are associated with increased costs 1-3 and mortality. 4;5 …”