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Costs and Outcomes Among Hemodialysis-Dependent Patients With Methicillin-Resistant or Methicillin-Susceptible Staphylococcus aureus Bacteremia

Published online by Cambridge University Press:  21 June 2016

Shelby D. Reed
Affiliation:
Center for Clinical and Genetic Economics, Annapolis, Maryland
Joëlle Y. Friedman
Affiliation:
Center for Clinical and Genetic Economics, Annapolis, Maryland
John J. Engemann
Affiliation:
Division of Infectious Diseases, Annapolis, Maryland
Robert I. Griffiths
Affiliation:
Health Economics Consulting, Annapolis, Maryland
Kevin J. Anstrom
Affiliation:
Center for Clinical and Genetic Economics, Annapolis, Maryland
Keith S. Kaye
Affiliation:
Duke Clinical Research Institute, Annapolis, Maryland Division of Infectious Diseases, Annapolis, Maryland
Martin E. Stryjewski
Affiliation:
Duke Clinical Research Institute, Annapolis, Maryland Division of Infectious Diseases, Annapolis, Maryland
Lynda A. Szczech
Affiliation:
Duke Clinical Research Institute, Annapolis, Maryland Division of Nephrology, Annapolis, Maryland
L. Barth Reller
Affiliation:
Division of Infectious Diseases, Annapolis, Maryland Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina
G. Ralph Corey
Affiliation:
Duke Clinical Research Institute, Annapolis, Maryland Division of Infectious Diseases, Annapolis, Maryland
Kevin A. Schulman
Affiliation:
Center for Clinical and Genetic Economics, Annapolis, Maryland
Vance G. Fowler Jr*
Affiliation:
Duke Clinical Research Institute, Annapolis, Maryland Division of Infectious Diseases, Annapolis, Maryland
*
Division of Infectious Diseases, Box 3281, Duke University Medical Center, Durham, NC 27710.vance.fowler@duke.edu

Abstract

Objective:

Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes of Staphylococcus aureus bacteremia. We compared costs and outcomes of methicillin resistance in patients with S. aureus bacteremia and a single chronic condition.

Design, Setting, and Patients:

We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease and S. aureus bacteremia hospitalized between July 1996 and August 2001. We used propensity scores to reduce bias when comparing patients with methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus bacteremia. Outcome measures were resource use, direct medical costs, and clinical outcomes at 12 weeks after initial hospitalization.

Results:

Fifty-four patients (37.8%) had MRSA and 89 patients (62.2%) had MSSA. Compared with patients with MSSA bacteremia, patients with MRSA bacteremia were more likely to have acquired the infection while hospitalized for another condition (27.8% vs 12.4%; P = .02). To attribute all inpatient costs to S. aureus bacteremia, we limited the analysis to 105 patients admitted for suspected S. aureus bacteremia from a community setting. Adjusted costs were higher for MRSA bacteremia for the initial hospitalization ($21,251 vs $13,978; P = .012) and after 12 weeks ($25,518 vs $17,354; P = .015). At 12 weeks, patients with MRSA bacteremia were more likely to die (adjusted odds ratio, 5.4; 95% confidence interval, 1.5 to 18.7) than were patients with MSSA bacteremia.

Conclusions:

Community-dwelling, hemodialysis-dependent patients hospitalized with MRSA bacteremia face a higher mortality risk, longer hospital stays, and higher inpatient costs than do patients with MSSA bacteremia.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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