Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
Infect Control Hosp Epidemiol. 2010 Apr;31(4):365-73. doi: 10.1086/651094.
To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults.
Retrospective study of all cases of S. aureus infection.
Department of Veterans Affairs hospital and associated clinics.
There were 390 patients with MSSA infections and 335 patients with MRSA infections.
We used medical records, accounting systems, and interviews to identify services rendered and costs for Minneapolis Veterans Affairs Medical Center patients with S. aureus infection with onset during the period from January 1, 2004, through June 30, 2006. We used regression analysis to adjust for patient characteristics.
Median 6-month unadjusted costs for patients infected with MRSA were $34,657, compared with $15,923 for patients infected with MSSA. Patients with MRSA infection had more comorbidities than patients with MSSA infection (mean Charlson index 4.3 vs 3.2; P < .001). For patients with Charlson indices of 3 or less, mean adjusted 6-month costs derived from multivariate analysis were $51,252 (95% CI, $46,041-$56,464) for MRSA infection and $30,158 (95% CI, $27,092-$33,225) for MSSA infection. For patients with Charlson indices of 4 or more, mean adjusted costs were $84,436 (95% CI, $79,843-$89,029) for MRSA infection and $59,245 (95% CI, $56,016-$62,473) for MSSA infection. Patients with MRSA infection were also more likely to die than were patients with MSSA infection (23.6% vs 11.5%; P < .001). MRSA infection was more likely to involve the lungs, bloodstream, and urinary tract, while MSSA infection was more likely to involve bones or joints; eyes, ears, nose, or throat; surgical sites; and skin or soft tissue (P < .001).
Resistance to methicillin in S. aureus was independently associated with increased costs. Effective antimicrobial stewardship and infection prevention programs are needed to prevent these costly infections.
确定耐甲氧西林金黄色葡萄球菌（MRSA）感染和甲氧西林敏感金黄色葡萄球菌（MSSA）感染成年患者的医疗费用差异。
所有金黄色葡萄球菌感染病例的回顾性研究。
退伍军人事务部医院及其相关诊所。
共有 390 例 MSSA 感染患者和 335 例 MRSA 感染患者。
我们使用病历、会计系统和访谈来确定明尼苏达州退伍军人事务医疗中心 2004 年 1 月 1 日至 2006 年 6 月 30 日期间发生的金黄色葡萄球菌感染患者的服务和费用。我们使用回归分析来调整患者特征。
未经调整的中位 6 个月 MRSA 感染患者费用为 34657 美元，而 MSSA 感染患者费用为 15923 美元。MRSA 感染患者比 MSSA 感染患者有更多的合并症（平均 Charlson 指数为 4.3 比 3.2；P <.001）。对于 Charlson 指数为 3 或更低的患者，多变量分析得出的中位调整后 6 个月费用为 MRSA 感染患者 51252 美元（95%CI，46041-56464），MSSA 感染患者 30158 美元（95%CI，27092-33225）。对于 Charlson 指数为 4 或更高的患者，MRSA 感染患者的中位调整费用为 84436 美元（95%CI，79843-89029），MSSA 感染患者为 59245 美元（95%CI，56016-62473）。MRSA 感染患者的死亡率也高于 MSSA 感染患者（23.6%比 11.5%；P <.001）。MRSA 感染更可能涉及肺部、血液和泌尿道，而 MSSA 感染更可能涉及骨骼或关节；眼睛、耳朵、鼻子或喉咙；手术部位；以及皮肤或软组织（P <.001）。
金黄色葡萄球菌对甲氧西林的耐药性与费用增加独立相关。需要有效的抗菌药物管理和感染预防计划来预防这些昂贵的感染。
