Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia.
OBJECTIVE
Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes of Staphylococcus aureus bacteremia. We compared costs and outcomes of methicillin resistance in patients with S. aureus bacteremia and a single chronic condition.


METHODS
We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease and S. aureus bacteremia hospitalized between July 1996 and August 2001. We used propensity scores to reduce bias when comparing patients with methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus bacteremia. Outcome measures were resource use, direct medical costs, and clinical outcomes at 12 weeks after initial hospitalization.


RESULTS
Fifty-four patients (37.8%) had MRSA and 89 patients (62.2%) had MSSA. Compared with patients with MSSA bacteremia, patients with MRSA bacteremia were more likely to have acquired the infection while hospitalized for another condition (27.8% vs 12.4%; P = .02). To attribute all inpatient costs to S. aureus bacteremia, we limited the analysis to 105 patients admitted for suspected S. aureus bacteremia from a community setting. Adjusted costs were higher for MRSA bacteremia for the initial hospitalization (21,251 dollars vs 13,978 dollars; P = .012) and after 12 weeks (25,518 dollars vs 17,354 dollars; P = .015). At 12 weeks, patients with MRSA bacteremia were more likely to die (adjusted odds ratio, 5.4; 95% confidence interval, 1.5 to 18.7) than were patients with MSSA bacteremia.


CONCLUSIONS
Community-dwelling, hemodialysis-dependent patients hospitalized with MRSA bacteremia face a higher mortality risk, longer hospital stays, and higher inpatient costs than do patients with MSSA bacteremia.
Reed
Shelby D
SD
Center for Clinical and Genetic Economics, USA.
Friedman
Joëlle Y
JY
Engemann
John J
JJ
Griffiths
Robert I
RI
Anstrom
Kevin J
KJ
Kaye
Keith S
KS
Stryjewski
Martin E
ME
Szczech
Lynda A
LA
Reller
L Barth
LB
Corey
G Ralph
GR
Schulman
Kevin A
KA
Fowler
Vance G
VG
D018806:APACHE; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000191:economics* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D016106:Methicillin Resistance; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000191:economics; D013203:Staphylococcal Infections / Q000150:complications / Q000191:economics* / Q000401:mortality; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects* / Q000472:pathogenicity; D016896:Treatment Outcome
D008712:Methicillin