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11 results

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

  • Gregory A. Filice, John A. Nyman, Catherine Lexau, Christine H. Lees, Lindsay A. Bockstedt, Kathryn Como-Sabetti, Lindsey J. Lesher, Ruth Lynfield
  • Journal: Infection Control & Hospital Epidemiology / Volume 31 / Issue 4 / April 2010
  • Published online by Cambridge University Press: 02 January 2015, pp. 365-373
  • Print publication: April 2010
  • Objective.

    To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults.

    Design.

    Retrospective study of all cases of S. aureus infection.

    Setting.

    Department of Veterans Affairs hospital and associated clinics.

    Patients.

    There were 390 patients with MSSA infections and 335 patients with MRSA infections.

    Methods.

    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.

    Results.

    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).

    Conclusions.

    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.

  • 36 - Trauma Systems, Triage, and Transfer

    • By John J. Como, Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Published online: 18 January 2010
  • Print publication: 23 June 2008, pp 569-578

  • Summary

    Objectives

    1. Define the concept of and the need for trauma systems.

    2. Relate the history and development of trauma systems in the United States.

    3. Discuss the role of the various trauma centers within the trauma system.

    4. Explain the principles of trauma patient triage.

    5. Describe the principles involved in transfer of the injured patient between institutions.

    TRAUMA SYSTEMS

    The cost to society due to trauma is enormous. Trauma is the leading cause of death for Americans 35 years of age and younger [1]. Traumatic injuries are estimated to be responsible for more than 161,000 deaths each year. In addition to mortality, trauma is significant for number of years of productive life lost and prolonged or permanent disability. For every person who dies of injury, an estimated 10 persons are hospitalized or transferred for specialized medical care, and 178 persons are treated and released from a hospital emergency department [1]. In 2000, there were an estimated 1,700,000 hospital discharges with a primary injury diagnosis [2]. The problem of injury has a profound effect on individuals, families, hospitals, and society at large because it causes tremendous medical, psychosocial, and financial burdens [1].

    Because of this, the prevention of traumatic injury and the treatment of the acutely injured patient are public services central to the mission of public health agencies. Trauma systems and trauma centers are essential to providing these public services.