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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 ,
Joëlle Y. Friedman ,
John J. Engemann ,
Robert I. Griffiths ,
Kevin J. Anstrom ,
Keith S. Kaye ,
Martin E. Stryjewski ,
Lynda A. Szczech ,
L. Barth Reller  and
G. Ralph Corey
...Show all authors
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
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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
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 175 - 183
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Diekema, DJ, Pfaller, MA, Schmitz, FJ, et al.Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32(suppl 2):S114–S132.CrossRefGoogle ScholarPubMed
2.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a 3-year analysis. Clin Infect Dis 1999;29:239–244.Google Scholar
3.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520–532.CrossRefGoogle ScholarPubMed
4.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.Google Scholar
5.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 charge. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, IL. Abstract K-1221.Google Scholar
6.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;5:9–17.CrossRefGoogle ScholarPubMed
7.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182–189.Google Scholar
8.Lewis, E, Saravolatz, LD. Comparison of methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia. Am J Infect Control 1985;13:109–114.Google Scholar
9.Marty, L, Flahault, A, Suarez, B, Caillon, J, Hill, C, Andremont, A. Resistance to methicillin and virulence of Staphylococcus aureus strains in bacteremic cancer patients. Intensive Care Med 1993;19:285–289.CrossRefGoogle Scholar
10.Mylotte, JM, Aeschlimann, JR, Rotella, DL. Staphylococcus aureus bacteremia: factors predicting hospital mortality. Infect Control Hosp Epidemiol 1996;17:165–168.Google Scholar
11.Mylotte, JM, Tayara, A. Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort. Clin Infect Dis 2000;31:1170–1174.Google Scholar
12.Roghmann, MC. Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia. Arch Intern Med 2000;160:1001–1004.Google Scholar
13.Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995;21:1417–1423.Google Scholar
14.Selvey, LA, Whitby, M, Johnson, B. Nosocomial methicillin-resistant Staphylococcus aureus bacteremia: is it any worse than nosocomial methicillin-susceptible Staphylococcus aureus bacteremia? Infect Control Hosp Epidemiol 2000;21:645–648.Google Scholar
15.Soriano, A, Martinez, JA, Mensa, J, et al.Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.CrossRefGoogle ScholarPubMed
16.Topeli, A, Unai, S, Akalin, HE. Risk factors influencing clinical outcome in Staphylococcus aureus bacteraemia in a Turkish University Hospital. Int JAntimicrob Agents 2000;14:57–63.CrossRefGoogle Scholar
17.McClelland, RS, Fowler, VG Jr, Sanders, LL, et al.Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality. Arch Intern Med 1999;159:1244–1247.CrossRefGoogle ScholarPubMed
18.Conterno, LO, Wey, SB, Castelo, A. Risk factors for mortality in Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 1998;19:32–37.CrossRefGoogle ScholarPubMed
19.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
20.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
21.Whitby, M, McLaws, ML, Berry, G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001;175:264–267.CrossRefGoogle ScholarPubMed
22.Dopirak, M, Hill, C, Oleksiw, M, et al.Surveillance of heinodialysis-asso-ciated primary bloodstream infections: the experience of ten hospital-based centers. Infect Control Hosp Epidemiol 2002;23:721–724.CrossRefGoogle ScholarPubMed
23.Taylor, G, Gravel, D, Johnston, L, et al.Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol 2002;23:716–720.CrossRefGoogle ScholarPubMed
24.Jean, G, Charra, B, Chazot, C, et al.Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron 2002;91:399–405.Google Scholar
25.Marr, KA, Kong, L, Fowler, VG, et al.Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int 1998;54:1684–1689.Google Scholar
26.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.CrossRefGoogle ScholarPubMed
27.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. Approved standard M100-S12.Google Scholar
28.Libman, H, Arbeit, RD. Complications associated with Staphylococcus aureus bacteremia. Arch Intern Med 1984;144:541–545.Google Scholar
29.Fowler, VG Jr, Olsen, MK, Corey, GR, et al.Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003;163:2066–2072.Google Scholar
30.Bureau of Labor Statistics. Bureau of Labor Statistics Data. Washington, DC: U.S. Department of Labor; 2003. Available at www.bls.gov/data.Google Scholar
31.Rosenbaum, PR, Rubin, DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70:41–55.CrossRefGoogle Scholar
32.Rubin, DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757–763.CrossRefGoogle ScholarPubMed
33.Rubin, DB. Using multivariate matched sampling and regression adjustment to control bias in observational studies. J Am Stat Assoc 1979;74:318–328.Google Scholar
34.D'Agostino, RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998;17:2265–2281.Google Scholar
35.Duan, N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc 1983;78:605–610.CrossRefGoogle Scholar
36.Small, PM, Chambers, HF. Vancomycin for Staphylococcus aureus endocarditis in intravenous drug users. Antimicrob Agents Chemother 1990;34:1227–1231.Google Scholar
37.Levine, DP, Fromm, BS, Reddy, BR. Slow response to vancomycin or vancomycin plus rifampin in methicillin-resistant Staphylococcus aureus endocarditis. Ann Intern Med 1991;115:674–680.Google Scholar
38.Hartstein, AI, Mulligan, ME, Morthland, VH, Kwok, RY. Recurrent Staphylococcus aureus bacteremia. J Clin Microbiol 1992;30:670–674.Google Scholar
39.Fowler, VG Jr, Kong, LK, Corey, GR, et al.Recurrent Staphylococcus aureus bacteremia: pulsed-field gel electrophoresis findings in 29 patients. J Infect Dis 1999;179:1157–1161.CrossRefGoogle ScholarPubMed
40.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.Google Scholar
41.Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99–104.Google Scholar
42.Rosenbaum, PR. Sensitivity analysis for certain permutation inferences in matched observational studies. Biometrika 1987;74:13–26.CrossRefGoogle Scholar
43.Fowler, VG Jr, Kong, LK, Corey, GR, et al.Recurrent Staphylococcus aureus bacteremia: pulsed-field gel electrophoresis findings in 29 patients. J Infect Dis 1999;179:1157–1161.Google Scholar
44.Chang, FY, Peacock, JE Jr, Musher, DM, et al.Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine 2003;82:333–339.CrossRefGoogle ScholarPubMed
45.Hartstein, AI, Mulligan, ME, Morthland, VH, Kwok, RY. Recurrent Staphylococcus aureus bacteremia. J Clin Microbiol 1992;30:670–674.Google Scholar