Impact of methicillin-resistant Staphylococcus aureus infections on key health economic outcomes: does reducing the length of hospital stay matter?

The clinical and economic impact of methicillin-resistant staphylococcal infections on the patient, the hospital and the community is significant and continues to increase. Methicillin-resistant Staphylococcus aureus infections, in particular, represent a substantial burden of resistant infections in the hospital. As such, it is important to analyse the cost parameters associated with an episode of infection. Key determinants of the total cost of an episode of infection include fixed costs and hotel costs; the contribution of antimicrobial therapy, including drug acquisition and delivery costs, is comparatively marginal. Therefore, decreasing the hospital length of stay by promoting earlier hospital discharge will significantly reduce overall costs and, in effect, increase the efficiency and cost-effectiveness of the hospital. Linezolid, the first marketed agent of a new class of oxazolidinone antibiotics, is effective in the treatment of serious Gram-positive infections. Its availability in both intravenous (iv) and oral formulations (the latter of which is 100% bioavailable) facilitates early discharge from hospital. Hospitalized patients with methicillin-resistant staphylococcal infections who were treated with either linezolid or vancomycin demonstrated no significant differences in clinical outcome or mortality. However, compared with vancomycin, administration of linezolid reduced the duration of iv therapy and increased the chance of being discharged during the first week of hospitalization. These effects were most pronounced in the subset of patients with skin and soft tissue infections. Knowledge of these data may influence prescribing practices at the individual and organizational levels and, in turn, reduce the economic burden associated with MRSS infections.