Excess Costs and Utilization Associated with Methicillin Resistance for Patients with <i>Staphylococcus aureus</i> Infection

Filice, Gregory; Nyman, John A.; Lexau, Catherine; Lees, Christine H.; Bockstedt, Lindsay; Como‐Sabetti, Kathryn; Lesher, Lindsey; Lynfield, Ruth

doi:10.1086/651094

Cited by 163 publications

(95 citation statements)

References 31 publications

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“…Widespread antimicrobial resistance has progressively limited safe and effective therapeutic options and has led to renewed efforts to develop prophylactic vaccines. A vaccine that protects against the large majority of nosocomial and community-acquired S. aureus strains could reduce the substantial morbidity and mortality associated with these common infections (13,22,23,26). However, the antigenic diversity of pathogenic S. aureus strains has complicated and slowed vaccine development (10,12,17,24,27,29,40,44).…”

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confidence: 99%

Safety and Immunogenicity of a Novel Staphylococcus aureus Vaccine: Results from the First Study of the Vaccine Dose Range in Humans

Harro

Betts

Orenstein

et al. 2010

Clin Vaccine Immunol

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Merck V710 is a novel vaccine containing the conserved Staphylococcus aureus iron surface determinant B shown to be protective in animal models. A phase I, multicenter, double-blind study of the dose range was conducted to assess the immunogenicity and safety of an adjuvanted liquid formulation of V710. A total of 124 adults (18 to 55 years of age) were randomized 1:1:1:1 to receive one 0.5-ml intramuscular injection of V710 (5 g, 30 g, or 90 g) or saline placebo. A positive immune response was defined as at least a 2-fold increase in IsdB-specific IgG levels from baseline levels. Local and systemic adverse events were assessed for 5 and 14 days, respectively, following vaccination. Positive immune responses were detected in 12 (67%) of the 18 subjects in the groups receiving 30 and 90 g V710 tested at day 10. At day 14, a significantly greater proportion of subjects manifested a positive immune response with higher geometric mean concentrations in the V710 30-g (86%; geometric mean concentration of 116 g/ml) and 90-g (87%; geometric mean concentration of 131 g/ml) dose groups than in the V710 5-g (29%; geometric mean concentration of 51 g/ml) or placebo (4%; geometric mean concentration of 23 g/ml) groups. Immune responses were durable through day 84. Subjects <40 and >40 years of age had comparable immune responses. The most common adverse events were injection-site pain, nausea, fatigue, and headache, usually of mild intensity. No immediate reactions or serious adverse events were reported. In this first study of V710 in humans, a single 30-g or 90-g dose was more immunogenic than the 5-g dose or placebo. Immune responses were evident by 10 to 14 days after vaccination in most responders.

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confidence: 99%

Safety and Immunogenicity of a Novel Staphylococcus aureus Vaccine: Results from the First Study of the Vaccine Dose Range in Humans

Harro

Betts

Orenstein

et al. 2010

Clin Vaccine Immunol

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“…discussion Screening and isolation, with or without efforts to eradicate carriage, have been associated with fewer secondary MRSA transmissions and a decreased rate of MRSA bacteremia. 9 Starting in 2004, we found the overall prevalence of MRSA colonization in hemodialysis patients over the 2004-2013 decade to be low at 3.6% (or 1.2% of all specimens obtained). At that time, the proportion of all S. aureus isolates from clinical specimens that was MRSA was approximately 8% for the entire country of Switzerland, varying from 4% in central to 14% in western Switzerland.…”

Section: Resultsmentioning

confidence: 88%

Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years’ Experience

Gebreselassie

Kaspar

Droz

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy.DESIGNScreening study and cost-effectiveness analysis.METHODSAnalysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate).RESULTSThere were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548).CONCLUSIONSIn an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.Infect. Control Hosp. Epidemiol. 2015;36(9):1046–1049

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“…Filice et al used this approach when faced with a similar issue in assessing predictors of healthcare costs. (70) An example of the model can be found in appendix F. …”

Section: Inferential Analysismentioning

confidence: 99%

Cost Effectiveness Analysis of Hygiene-Based Strategies Aimed Toward Prevention of SSTI and MRSA-Associated SSTI Among U.S. Active Duty Army Trainees

Morrison¹

2015

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iii ACKNOWLEDGMENTSThere are many individuals and organizations that I would like to thank. Without your support this research would never have come to fruition. To the many family and friends that have supported me through the course of this multi-year process, I thank you. To my late father, thanks for believing in me and pushing me to be the very best of myself. The many early struggles were worth it. COPYRIGHT STATEMENTThe author hereby certifies that the use of any copyrighted material in the dissertation manuscript entitled: Cost effectiveness of hygiene strategies aimed toward prevention of SSTI and MRSA-associated SSTI aniong U.S. active duty Army trainees is appropriately acknowledged and, beyond brief excerpts, is with the permission of the copyright owner.[Signature]Stephanie M. Morrison Military health systems datasets were used to retrospectively evaluate lost-time in training and cost burden of overall, S.aureus and MRSA SSTI. ICD-9-CM codes were used to identify skin and soft tissue infections, these codes were then linked with clinical microbiology information to identify S.aureus and MRSA SSTI. Lost time in training was calculated as the sum of time spent away from training due to clinic or hospital visits as well as convalescence and training remediation. Cost of illness was equivalent to the sum of direct medical costs (costs associated with medical care such as office visits, laboratory procedures, and prescriptions) and indirect costs (costs associated with lost work productivity because of illness). A systematic review of the literature was performed to determine the effects of hand and personal hygiene programs aimed toward acute infections like SSTI in terms of risk reduction. Additionally, the cost effectiveness of hygiene strategies aimed toward overall and MRSA SSTI among recruit trainees was evaluated using information obtained from a prospective trial implemented at Fort Benning, Georgia. A decision analysis framework was constructed and cost effectiveness was computed using the costs averted and time averted when using a certain strategy compared to standard practice along the infection pathway. Complicated infections contributed to increased rates, lost time in training, and costs.Increased lost time and costs was observed among those trainees with an overall SSTI who were cultured positive for MRSA, received an I&D procedure and prescribed an antibiotic regimen that covered for MRSA.A systematic review and meta-analysis of the literature revealed that hand and personal hygiene promotions programs had a beneficial effect toward acute communicable infections like gastrointestinal, respiratory, and skin infections. Further analysis revealed that significant heterogeneity existed around the pooled risk ratios, the source of which was not identified. Although a chlorhexidine strategy with a hygiene component was shown to be protective against SSTI within the community, results should be viewed with caution. The studies used to generate this pooled estimate were observational-analytic b...

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

Abstract: 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.

Cited by 163 publications

References 31 publications

Safety and Immunogenicity of a Novel Staphylococcus aureus Vaccine: Results from the First Study of the Vaccine Dose Range in Humans

Safety and Immunogenicity of a Novel Staphylococcus aureus Vaccine: Results from the First Study of the Vaccine Dose Range in Humans

Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years’ Experience

Cost Effectiveness Analysis of Hygiene-Based Strategies Aimed Toward Prevention of SSTI and MRSA-Associated SSTI Among U.S. Active Duty Army Trainees

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