Cai Yiying, Philip Edwin C, Arora Shalvi, Sim Jean X Y, Chow Weien, Nazeha Nuraini, Whiteley Sean, Tiang Daniel C, Neo Siow Leng, Hong Weiwei, Venkatachalam Indumathi, Graves Nicholas
Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
IJID Reg. 2024 Aug 21;12:100427. doi: 10.1016/j.ijregi.2024.100427. eCollection 2024 Sep.
We used a multi-state model, which mitigates time-dependent bias, to estimate the mortality, length of stay (LOS), and costs of methicillin-resistant (MRSA) infections in Singapore.
We conducted a retrospective study in a hospital in Singapore from 2018 to 2022. Patients with MRSA infections were matched 1:1:3 to patients with MRSA colonization and patients without MRSA by age, gender, specialty, and intensive care admission, respectively. A multi-state model was used to derive excess LOS and mortality hazard ratios. The attributable cost of infections was estimated in 2022 Singapore dollars (SGDs) from the health care perspective.
We matched 536 patients with MRSA infections to 536 patients with MRSA colonization, and to 1608 patients without MRSA. The excess LOS due to MRSA infection was 2.11 (95% confidence interval [CI] 2.05-2.17) days compared with MRSA colonization and 3.75 (95% CI 3.69-3.80) days compared with no MRSA, which translated to an excess cost of SGD $1825 and SGD $3238, respectively. Of the different MRSA infection types, pneumonia had the highest mortality risk (hazard ratio 4.13; 95% CI 2.28-7.50) compared with patients without MRSA.
MRSA infections increased hospital LOS and health care costs in Singapore. Our estimates can inform future economic analyses of management strategies against MRSA.
我们使用了一个多状态模型来估计新加坡耐甲氧西林金黄色葡萄球菌（MRSA）感染的死亡率、住院时间（LOS）和成本，该模型可减轻时间依赖性偏差。
我们在新加坡一家医院进行了一项回顾性研究，研究时间为2018年至2022年。分别根据年龄、性别、专业和重症监护入院情况，将MRSA感染患者与MRSA定植患者以及无MRSA患者按1:1:3进行匹配。使用多状态模型得出额外住院时间和死亡风险比。从医疗保健角度，以2022年新加坡元（SGD）估算感染的归因成本。
我们将536例MRSA感染患者与536例MRSA定植患者以及1608例无MRSA患者进行了匹配。与MRSA定植相比，MRSA感染导致的额外住院时间为2.11天（95%置信区间[CI]2.05 - 2.17），与无MRSA相比为3.75天（95%CI 3.69 - 3.80），分别转化为额外成本1825新元和3238新元。在不同类型的MRSA感染中，与无MRSA患者相比，肺炎的死亡风险最高（风险比4.13；95%CI 2.28 - 7.50）。
MRSA感染增加了新加坡的住院时间和医疗保健成本。我们的估计可为未来针对MRSA的管理策略的经济分析提供参考。
