Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: relationships with antibiotic use and cost drivers.
BACKGROUND
Increased incidence of nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) has been associated with the use of certain antibiotics and has resulted in increased morbidity, mortality, and costs of care.


OBJECTIVE
To describe relationships between vancomycin and linezolid use and incidence of these nosocomial infections over time and to determine factors associated with the increased costs of care (cost drivers) associated with affected patients.


METHODS
The association between institution-wide antibiotic use and the rate of nosocomial MRSA and VRE infections was assessed using segmented regression analysis for interrupted time series. The effect that patient characteristics and procedures, as well as certain antibiotic use, had on costs and length of stay of patients with MRSA or VRE nosocomial infection was also assessed and cost drivers for the 2 types of infections were compared.


RESULTS
Our analysis included 206 patients who developed MRSA (n = 187) or VRE (n = 19) nosocomial infection. Although small numbers of VRE nosocomial infection may limit generalizations from our results, we found no significant relationship between vancomycin or linezolid use and the rate of either infection. While mean hospital costs were similar, cost drivers varied somewhat between infection types.


CONCLUSIONS
The incidence of MRSA or VRE infections does not appear to be related to the use of vancomycin or linezolid. Costs of care are quite high in some affected patients and, while mean total hospital costs are similar, cost drivers appear to differ between the 2 infection types.
Mauldin
Patrick D
PD
Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA.
Salgado
Cassandra D
CD
Durkalski
Valerie L
VL
Bosso
John A
JA
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000209:etiology; D016983:Enterococcus / Q000187:drug effects; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D016106:Methicillin Resistance / Q000187:drug effects; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D013211:Staphylococcus aureus / Q000187:drug effects; D020713:Vancomycin Resistance / Q000187:drug effects
D000900:Anti-Bacterial Agents