title: Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia.
abstract: 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.
authors.affiliation: Center for Clinical and Genetic Economics, USA.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Joëlle Y
authors.initials: JY
authors.lastname: Friedman
authors.forename: John J
authors.initials: JJ
authors.lastname: Engemann
authors.forename: Robert I
authors.initials: RI
authors.lastname: Griffiths
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Martin E
authors.initials: ME
authors.lastname: Stryjewski
authors.forename: Lynda A
authors.initials: LA
authors.lastname: Szczech
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
mesh_terms: 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
chemical_list: D008712:Methicillin