Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: Impact of length of stay and intensity of care

Thampi, Nisha; Showler, Adrienne; Burry, Lisa; Bai, Anthony D.; Steinberg, Marilyn; Ricciuto, Daniel R.; Bell, Chaim M.; Morris, Andrew M.

doi:10.1016/j.ajic.2015.01.031

Cited by 58 publications

(56 citation statements)

References 21 publications

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“…The length of hospital stay is a major contributing factor to hospital costs 23 . In addition to an increase in daily bed cost, the prolonged length of hospital stay may be related to more treatment and diagnostic services, which yield substantial hospital costs; therefore, we did not include length of hospital stay in PSM analyses 44 .…”

Section: Discussionmentioning

confidence: 99%

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

Zhen

Lundborg

Zhang

et al. 2020

Sci Rep

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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...

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Section: Discussionmentioning

confidence: 99%

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

Zhen

Lundborg

Zhang

et al. 2020

Sci Rep

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“…Furthermore, the morbidity from SAB is striking, with 10 to 15% of episodes being complicated by endocarditis or a risk of metastatic disease elsewhere in the body (9,10). The financial consequences of SAB are also significant, with health care costs ranging from $12,078 to $25,573 per episode of SAB (11)(12)(13). Typically, SAB is treated with narrow-spectrum beta-lactam antibiotics for methicillin-susceptible S. aureus (MSSA) isolates and the glycopeptide antibiotic vancomycin for methicillin-resistant S. aureus (MRSA) isolates (14)(15)(16)(17).…”

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confidence: 99%

Vancomycin MIC Does Not Predict 90-Day Mortality, Readmission, or Recurrence in a Prospective Cohort of Adults with Staphylococcus aureus Bacteremia

Baxi

Clemenzi-Allen

Gahbauer

et al. 2016

Antimicrob Agents Chemother

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Staphylococcus aureus is a leading cause of bacteremia (1, 2). Even when an individual is appropriately treated, the risk of mortality from S. aureus bacteremia (SAB) is 20 to 40% per episode (3-8). Furthermore, the morbidity from SAB is striking, with 10 to 15% of episodes being complicated by endocarditis or a risk of metastatic disease elsewhere in the body (9, 10). The financial consequences of SAB are also significant, with health care costs ranging from $12,078 to $25,573 per episode of SAB (11-13). Typically, SAB is treated with narrow-spectrum beta-lactam antibiotics for methicillin-susceptible S. aureus (MSSA) isolates and the glycopeptide antibiotic vancomycin for methicillin-resistant S. aureus (MRSA) isolates (14-17). Isolates with vancomycin MICs of Յ2 g/ml are considered susceptible, those with MICs of 4 to 8 g/ml are considered intermediately resistant, and those with MICs of Ͼ8 g/ml are designated resistant (18). The question of whether infection by S. aureus strains with vancomycin MICs of 2 g/ml is associated with worse outcomes has been a topic of much research, although a consensus has not been reached. Compared with research methods such as Epsilometer testing (Etest) or broth microdilution (BMD), automated MIC measurements can be off by 1 dilution in either direction (e.g., a value of 2 g/ml could mean 1 or 4 g/ml if repeated) (19,20), which adds to the deliberation over interpreting study results, although consistency between BMD and Etest results can also vary. In addition, most studies have focused on MRSA, but the role of vancomycin MIC in MSSA infection has not been fully evaluated. A number of studies, including systematic reviews and meta-analyses, have demonstrated increased mortality in the setting of SAB with vancomycin MICs of Ն2.0 g/ml (21-28). Conversely, others have shown an increased risk of mortality in individuals with MICs of Ͻ2.0 g/ml (29-32). In spite of these data, the majority of studies have failed to show any significant increase in the risk of mortality attributable to vancomycin MIC (5,26,. A recent rigorous meta-analysis failed to demonstrate increased 30-day or in-hospital mortality attributable to vancomycin MIC, irrespective of the MIC cutoff that was chosen (1.5, 2.0, 4.0, or 8.0 g/ml) (5). Although valuable, meta-analyses are lim-

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“…One way to estimate it is to determine the share of human resources allocated to those alternatives out of the total human resources allocated to psychiatry in a given hospital. Human resources indeed represent 70% of the hospital budget for the treatment of somatic illnesses [50,51] and it is estimated that this percentage is even higher for the care of psychiatric disorders [52,53,54]. The development of AFTH was therefore estimated by the ratio of the number of full-time equivalents (FTEs) of staff working in departments providing alternatives to full-time hospitalizations over the total number of FTEs in the hospital to which each sector belonged, i.e., (total number of FTEs—total number of FTEs in full-time hospitalization)/total number of FTEs.…”

Section: Methodsmentioning

confidence: 99%

The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry

Gandré

Gervaix

Thillard

et al. 2017

IJERPH

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International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.

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Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: Impact of length of stay and intensity of care

Cited by 58 publications

References 21 publications

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

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

Vancomycin MIC Does Not Predict 90-Day Mortality, Readmission, or Recurrence in a Prospective Cohort of Adults with Staphylococcus aureus Bacteremia

The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry

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