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Excess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection

  • Gregory A. Filice (a1) (a2), John A. Nyman (a3), Catherine Lexau (a4), Christine H. Lees (a4), Lindsay A. Bockstedt (a3), Kathryn Como-Sabetti (a4), Lindsey J. Lesher (a4) and Ruth Lynfield (a4)...



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.


Corresponding author

Infectious Disease Section (111F), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417 (


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1. Barber, M. Methicillin-resistant staphylococci. J Clin Pathol 1961;14:385393.
2. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
3. Hota, B, Ellenbogen, C, Hayden, MK, Aroutcheva, A, Rice, TW, Weinstein, RA. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 2007;167:10261033.
4. Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787794.
5. Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007;13:18401846.
6. Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352: 14361444.
7. Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:14331437.
8. Rubin, RJ, Harrington, CA, Poon, A, Dietrich, K, Greene, JA, Moiduddin, A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:917.
9. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36: 592598.
10. Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99104.
11. McHugh, CG, Riley, LW. Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections. Infect Control Hosp Epidemiol 2004;25:425430.
12. Shorr, AF, Tabak, YP, Gupta, V, Johannes, RS, Liu, LZ, Kollef, MH. Morbidity and cost burden of methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia. Crir Care 2006;10:R97.
13. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166174.
14. Lodise, TP, McKinnon, PS. Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis 2005;52:113122.
15. Reed, SD, Friedman, JY, Engemann, JJ, et al. Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicil-lin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2005;26:175183.
16. Department of Veterans Affairs. VHA Decision Support System (DSS)—Introduction. 2008. Accessed March 6, 2009.
17. Barnett, PG. Determination of VA health care costs. Med Care Res Rev 2003;60(Suppl 3):124S141S.
18. Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004.
19. NCCLS. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: NCCLS; 2002.
20. Department of Veterans Affairs. Veterans Health Information Systems and Technology Architecture (VistA)—description. Washington, DC: Department of Veterans Affairs. Accessed March 6, 2009.
21. Health Economics Resource Center. General cost-effectiveness analysis issues—how do I adjust for the effects of inflation? Washington, DC: Department of Veterans Affairs; 2008. Accessed March 27, 2009.
22. Manning, WG, Mullahy, J. Estimating log models: to transform or not to transform? J Health Econ 2001;20:461494.
23. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.
24. Duan, N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc 1983;78:605610.
25. Manning, WG. The logged dependent variable, heteroscedasticity, and the retransformation problem. J Health Econ 1998;17:283295.
26. Greene, WH. Econometric Analysis. Upper Saddle River, NJ: Prentice Hall; 2003.
27. Gould, IM. Costs of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) and its control. Int I Antimicrob Agents 2006;28:379384.
28. Chu, VH, Crosslin, DR, Friedman, JY, et al. Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes. Am J Med 2005;118:1416.
29. Shorr, AF. Epidemiology of staphylococcal resistance. Clin Infect Dis 2007;45(Suppl 3):S171S176.
30. Noskin, GA, Rubin, RJ, Schentag, JJ, et al. The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample Database. Arch Intern Med 2005;165:17561761.
31. Kanerva, M, Blom, M, Tuominen, U, et al. Costs of an outbreak of meticillin-resistant Staphylococcus aureus . J Hosp Infect 2007;66:2228.
32. Herr, CE, Heckrodt, TH, Hofmann, FA, Schnettler, R, Eikmann, TF. Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 2003;24:673678.
33. Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971978.
34. Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301:727736.
35. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.
36. McQuillen, DP, Petrak, RM, Wasserman, RB, Nahass, RG, Scull, JA, Martinelli, LP. The value of infectious diseases specialists: non-patient care activities. Clin Infect Dis 2008;47:10511063.

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Excess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection

  • Gregory A. Filice (a1) (a2), John A. Nyman (a3), Catherine Lexau (a4), Christine H. Lees (a4), Lindsay A. Bockstedt (a3), Kathryn Como-Sabetti (a4), Lindsey J. Lesher (a4) and Ruth Lynfield (a4)...


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