Costs and Outcomes Among Hemodialysis-Dependent Patients With Methicillin-Resistant or Methicillin-SusceptibleStaphylococcus aureusBacteremia

Abstract

AbstractObjective:Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes ofStaphylococcus aureusbacteremia. We compared costs and outcomes of methicillin resistance in patients withS. aureusbacteremia and a single chronic condition.Design, Setting, and Patients:We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease andS. aureusbacteremia 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. aureusbacteremia. 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 toS. aureusbacteremia, we limited the analysis to 105 patients admitted for suspectedS. aureusbacteremia 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.