title: An economic model for the prevention of MRSA infections after surgery: non-glycopeptide or glycopeptide antibiotic prophylaxis?
abstract: OBJECTIVE
  Surgical site infection is commonly caused by Staphylococcus aureus. The multiresistant strains (MRSA) are resistant to most antibiotic prophylaxis regimens. Our aim was to explore whether there is a threshold of MRSA prevalence at which switching to routine glycopeptide-based antibiotic prophylaxis becomes cost-effective.
  
  
  METHODS
  An indicative model was designed to explore the cost-effectiveness of vancomycin, cephalosporin or a combination, in patients undergoing primary hip arthroplasty.
  
  
  RESULTS
  If the MRSA infection rate is equal to or above 0.25% and the rate of other infections with cephalosporin prophylaxis is equal to or above 0.2%, use of the combination antibiotic prophylaxis is optimal.
  
  
  CONCLUSIONS
  Modelling the cost-effectiveness of interventions for MRSA prevention is complex due to uncertainty around resistance and effectiveness of glycopeptides.
  
  
  CONCLUSIONS
  The indicative model provides a framework for evaluation. More work is needed to understand the impact of antibiotic resistance over time in these currently effective antibiotics.
authors: Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK. rachel.elliott@nottingham.ac.uk
authors: Rachel A
authors: RA
authors: Elliott
authors: Helen L A
authors: HL
authors: Weatherly
authors: Neil S
authors: NS
authors: Hawkins
authors: Gillian
authors: G
authors: Cranny
authors: Duncan
authors: D
authors: Chambers
authors: Lindsey
authors: L
authors: Myers
authors: Alison
authors: A
authors: Eastwood
authors: Mark J
authors: MJ
authors: Sculpher
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000706:statistics & numerical data; D019644:Arthroplasty, Replacement, Hip; D002511:Cephalosporins / Q000191:economics* / Q000627:therapeutic use; D016001:Confidence Intervals; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D006020:Glycopeptides / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus; D018803:Models, Economic; D016017:Odds Ratio; D019057:Quality-Adjusted Life Years; D013203:Staphylococcal Infections / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000191:economics* / Q000401:mortality / Q000517:prevention & control; D006113:United Kingdom; D014640:Vancomycin / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D006020:Glycopeptides; D014640:Vancomycin