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Inappropriate therapy for methicillin-resistant Staphylococcus aureus: resource utilization and cost implications.
Andrew F Shorr1, Scott T Micek, Marin H Kollef
1Pulmonary and Critical Care Medicine Service, Washington Hospital Center and Georgetown University, Washington, DC, USA. afshorr@dnamail.com
Critical Care Medicine
|July 4, 2008
Summary
Inappropriate antibiotic therapy for methicillin-resistant Staphylococcus aureus (MRSA) significantly increases hospital length of stay and costs. Prompt administration of appropriate antibiotics for MRSA infections is crucial for improving patient outcomes and reducing healthcare expenses.
Area of Science:
- Infectious Diseases
- Health Economics
- Clinical Pharmacy
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with substantial patient morbidity and mortality.
- Initial antibiotic treatment that is not appropriate for MRSA increases mortality risk.
- The effect of inappropriate initial antibiotic therapy on hospital length of stay and associated costs was previously unknown.
Purpose of the Study:
- To determine the impact of initially inappropriate antibiotic therapy on hospital length of stay and costs in patients with sterile-site methicillin-resistant Staphylococcus aureus infections.
- To compare outcomes between patients receiving appropriate versus initially inappropriate antibiotic therapy for MRSA infections.
Main Methods:
- A retrospective study of patients with non-nosocomial MRSA sterile-site infections over a 3-year period.
- Comparison of hospital length of stay and total costs between patients receiving appropriate (in vitro susceptible and timely administered) and initially inappropriate antibiotic therapy.
- Statistical adjustment for confounders including demographics, comorbidities, infection characteristics, and illness severity.
Main Results:
- The study included 291 patients; 77% received initially inappropriate antibiotic therapy.
- Appropriately treated patients had a median length of stay 2 days shorter (7.1 vs. 9.3 days, p = .050) compared to inappropriately treated patients.
- Median crude hospital costs were significantly lower for appropriately treated patients ($13,688 vs. $19,427, p = .019).
- Adjusted analysis confirmed that appropriate therapy was associated with a reduced length of stay (HR: 0.69, p = .013).
Conclusions:
- Initially inappropriate antibiotic therapy for methicillin-resistant Staphylococcus aureus sterile-site infections leads to prolonged hospital stays and increased healthcare costs.
- Reducing the incidence of inappropriate initial antibiotic therapy for MRSA infections can improve patient outcomes and benefit healthcare systems.
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