An economic model for the prevention of MRSA infections after surgery: non-glycopeptide or glycopeptide antibiotic prophylaxis?
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.
Elliott
Rachel A
RA
Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK. rachel.elliott@nottingham.ac.uk
Weatherly
Helen L A
HL
Hawkins
Neil S
NS
Cranny
Gillian
G
Chambers
Duncan
D
Myers
Lindsey
L
Eastwood
Alison
A
Sculpher
Mark J
MJ
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
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D006020:Glycopeptides; D014640:Vancomycin