National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010–2014

Klein, Eili Y.; Jiang, Wendi; Mojica, Nestor; Tseng, Katie K; McNeill, Ryan; Cosgrove, Sara E.; Perl, Trish M.

doi:10.1093/cid/ciy399

Cited by 60 publications

(83 citation statements)

References 22 publications

(26 reference statements)

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“…Therefore, it is important to select variables in the PSM analysis. Some variables representing the severity of illness, including whether admitted to the ICU, whether undergoing surgery, complications or underlying disease, were included in the PSM analyses to decrease the influence of these variables on the main indicators; however, we excluded some variables that were directly related to hospital costs, such as length of hospital stay, length of ICU stay, and number of surgeries 44 , which is consistent with some studies 13,48 . Some caution should be taken in the interpretation of these results.…”

Section: Discussionmentioning

confidence: 95%

“…The hospital mortality rate between MRSA and MSSA inpatients has long been controversial, and the results in some studies are inconsistent 12,16,17,20,33,40,45,46 . It was reported that patients with MRSA pneumonia infections had a higher mortality rate than those with MSSA (P < 0.001) 13 . In our study, we found that there were no differences in the hospital mortality rate between MRSA and MSSA inpatients; however, a significant difference existed between MRSA inpatients and those without an S. aureus infection, and this is consistent with some other studies conducted in China [34][35][36]38 .…”

Section: Discussionmentioning

confidence: 98%

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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: 95%

Section: Discussionmentioning

confidence: 98%

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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“…It has been estimated that in 2001 S. aureus infections afflicted 292 045 US hospital inpatients, caused almost 12 000 inpatient deaths and cost $9.5 billion in excess charges in US hospitals alone 41 . By 2014, the number of US inpatients afflicted with Methicillin-Susceptible and Methicillin-Resistant S. aureus alone has risen dramatically to 616 070 individuals and associated costs were estimated to be around $14.6 billion 42 . Therefore finding new treatments against aureus infections is absolutely essential.…”

Section: Discussionmentioning

confidence: 99%

ChronicStaphylococcus aureusinfection is cured by theory-driven therapy

Zhao

Khailaie

et al. 2020

Preprint

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19Staphylococcus aureus (S. aureus) is a challenging human pathogen due to its ability to evade the 20 immune system and resist multidrug antibiotics. These evasive strategies lead to chronic and re-21 current infections. Many studies have documented that during chronic infections Myeloid Derived 22 Suppressor Cells (MDSCs) exert immunosuppressive mechanisms on T cells. A mathematical 23 model explains how the steady state of chronic infection can be disturbed and suggests therapeutic 24 strategies to clear the infection. Model-driven suggestions were tested experimentally and con-25 firmed complete clearance of S. aureus chronic infection. 26 Keywords 27 Myeloid Derived Suppressor Cells, MDSCs, Staphylococcus aureus, chronic infection, mathematical model, 28 therapy, cure, heat-killed cells 29Staphylococcus aureus (S. aureus) is a bacterial human pathogen colonizing 20%-30% of the world pop-30 ulation and responsible for the genesis of nosocomial-acquired and community-acquired bacterial infections. 31 Colonization by S. aureus is typically asymptomatical, implying an equilibrated state between host and bac-32 terium. However, the bacterium can become opportunistic often post-surgery or after implantation of medical 33 devices and can cause skin and soft tissue infections, such as dermatitis, impetigo, and cellulitis 1 , as well as 34 life-threatening conditions like pneumonia and chronic osteomyelitis 2 . Additionally, individuals with immune 35 deficiencies are more susceptible to S. aureus infections. The pathogen constitutes a serious problem in clin-36 ics worldwide because it uses multiple mechanisms to persist in the host. These include strategies of bacterial 37 1 evasion, multi-drug antibiotic resistance, immunosuppression 3 or manipulation of the host's immune regulatory 38 mechanisms, 4;5 which lead to chronic and difficult-to-treat infections. 39Typically, immunosuppression is achieved via regulatory T cells (Tregs), T cell lysis, regulatory B cells 40 (Bregs) 6 , and Myeloid-Derived Suppressor Cells (MDSCs). In the case of S. aureus chronic infections, immuno-41 suppression is not attributed to Bregs, tolerogenic dendritic cells, nor Tregs 7 . Treg-depletion has only a minor 42 effect, whereas T-cell proliferation remains inhibited despite the absence of B220 + and CD11c + cells 7 . Never-43 theless, T-cell suppression in chronically infected mice has been associated with the expansion of monocytic-like 44 (CD11b + Ly6C + Ly6G low phenotype), neutrophilic-like (CD11b + Ly6C low Ly6G + phenotype) and eosonophilic-45 like (CD11b + Ly6C low Ly6G low phenotype) MDSCs 7;8;9;10;11 , affirming the dominant immunosuppressive role of 46 MDSCs during chronic S. aureus infections. 47MDSCs constitute a heterogeneous population of immature myeloid cells, which exert their suppressive 48 effect on T cells by producing reactive oxygen species, nitric oxide, arginase, and inducible nitric oxide syn-49 thase. Significant MDSC expansion and the consequent immunosuppressive effect were reported in long-lasting 50 p...

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“…Although methicillin is no longer used clinically, the MSSA and MRSA terminologies persist. Both MSSA, and even more so MRSA, infections have significant morbidity and mortality . MSSA is treatable today by a variety of penicillins and cephalosporins .…”

Section: Sensing and Evading The β‐Lactam Antibiotics By A Gram‐positmentioning

confidence: 99%

“…Both MSSA, and even more so MRSA, infections have significant morbidity and mortality. 129 MSSA is treatable today by a variety of penicillins and cephalosporins. 130 MRSA was previously a primarily nosocomial infection, but today is seen routinely also as a community-acquired infection.…”

Section: Sensing and Evading The β-Lactam Antibiotics By A Gram-posmentioning

confidence: 99%

Constructing and deconstructing the bacterial cell wall

Fisher

Mobashery

2019

Protein Science

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The history of modern medicine cannot be written apart from the history of the antibiotics. Antibiotics are cytotoxic secondary metabolites that are isolated from Nature. The antibacterial antibiotics disproportionately target bacterial protein structure that is distinct from eukaryotic protein structure, notably within the ribosome and within the pathways for bacterial cell‐wall biosynthesis (for which there is not a eukaryotic counterpart). This review focuses on a pre‐eminent class of antibiotics—the β‐lactams, exemplified by the penicillins and cephalosporins—from the perspective of the evolving mechanisms for bacterial resistance. The mechanism of action of the β‐lactams is bacterial cell‐wall destruction. In the monoderm (single membrane, Gram‐positive staining) pathogen Staphylococcus aureus the dominant resistance mechanism is expression of a β‐lactam‐unreactive transpeptidase enzyme that functions in cell‐wall construction. In the diderm (dual membrane, Gram‐negative staining) pathogen Pseudomonas aeruginosa a dominant resistance mechanism (among several) is expression of a hydrolytic enzyme that destroys the critical β‐lactam ring of the antibiotic. The key sensing mechanism used by P. aeruginosa is monitoring the molecular difference between cell‐wall construction and cell‐wall deconstruction. In both bacteria, the resistance pathways are manifested only when the bacteria detect the presence of β‐lactams. This review summarizes how the β‐lactams are sensed and how the resistance mechanisms are manifested, with the expectation that preventing these processes will be critical to future chemotherapeutic control of multidrug resistant bacteria.

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National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010–2014

Abstract: Though MRSA infections had been previously associated with higher hospitalization costs, our results suggest that in recent years, costs associated with MSSA-related infections have converged with and may surpass costs of similar MRSA-related hospitalizations.

Cited by 60 publications

References 22 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

ChronicStaphylococcus aureusinfection is cured by theory-driven therapy

Constructing and deconstructing the bacterial cell wall

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