Eradication of nasal carriage of Staphylococcus aureus--is it cost-effective?
In cardiothoracic surgery, the costs of surgical-site infection (SSI) arise from additional postoperative procedures (approximately US $5000 per patient) and prolonged hospital stay (approximately $11,500 per patient). Application of nasal mupirocin reduced SSIs by 63% compared with historical controls. This would have resulted in savings provided that the attributable cost of an SSI was more than $245. Mupirocin was estimated to reduce the risk of bacteraemia in haemodialysis patients by 84% compared with historical controls. A model using data on Medicare payments for haemodialysis admissions was used to estimate the impact on hospital costs. The conclusion was that mupirocin would have been cost-saving but the model did not provide sufficient detail about hospital costing to allow assessment of its relevance in other settings. In a prospective, randomized, placebo-controlled trial in continuous ambulatory peritoneal dialysis (CAPD) patients, mupirocin reduced the risk of staphylococcal exit-site infection (ESI) from 0.42 to 0.14 per patient-year. However, as in a previous comparison with historical controls, there was an increase in the rates of ESIs caused by Gram-negative bacteria in patients who received mupirocin, bringing the rate of total ESIs up to that observed in the placebo group. There was some evidence that infections caused by Gram-negative bacteria had less severe consequences than staphylococcal infections. It is concluded that application of nasal mupirocin to nasal carriers of Staphylococcus aureus may be cost-saving in patients undergoing cardiac surgery or haemodialysis but, if the analysis is restricted to the cost of management of ESIs, it may not be cost-saving in CAPD. However, reducing the risk of staphylococcal ESI may reduce the risk of catheter loss and subsequent transfer to haemodialysis and this merits further study.
Department of Clinical Pharmacology, Ninewells Hospital, Dundee, Scotland.
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Davey
D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D002353:Carrier State / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D006801:Humans; D016712:Mupirocin / Q000191:economics / Q000627:therapeutic use; D009666:Nose / Q000382:microbiology*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000191:economics; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics; D013203:Staphylococcal Infections / Q000191:economics / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000191:economics
D000900:Anti-Bacterial Agents; D016712:Mupirocin