Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia
Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia
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DOI：
10.1086/502523
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发表时间：
2005-02-01
影响因子：
4.5
通讯作者：
Fowler, VG
中科院分区：
文献类型：
--
作者：
Reed, SD;Friedman, JY;Fowler, VG
目的：对于金黄色葡萄球菌菌血症的成本和结果，甲氧西林耐药的后果先前的分析变得复杂。我们比较了金黄色葡萄球菌菌血症和单一慢性疾病患者耐甲氧西林的成本和结果。设计、设置和患者：我们对1996年7月至2001年8月住院的血液透析依赖的终末期肾病和金黄色葡萄球菌菌血症患者进行了前瞻性队列研究。当比较耐甲氧西林金黄色葡萄球菌(MRSA)和敏感甲氧西林金黄色葡萄球菌(MSSA)菌血症的患者时，我们使用倾向性评分来减少偏倚。结果：54例(37.8%)患者有MRSA，89例(62.2%)患者有MSSA。与MSSA菌血症患者相比，MRSA菌血症患者在因其他疾病住院期间感染的可能性更大(27.8%比12.4%；P=0.02)。为了将所有住院费用归因于金黄色葡萄球菌菌血症，我们将分析限于105名来自社区的疑似金黄色葡萄球菌菌血症入院患者。MRSA菌血症的调整成本在最初住院(21,251美元对13,978美元；P=.012)和12周后(25,518美元对17,354美元；P=.015)较高。在12周时，患有MRSA菌血症的患者比患有MSSA菌血症的患者更有可能死亡(调整后的优势比为5.4；95%可信区间为1.5至18.7)。结论：社区居住的依赖血液透析的MRSA菌血症患者与MSSA菌血症患者相比，面临更高的死亡风险、更长的住院时间和更高的住院费用(Infect Control Hosp Epidinool 2005；26：175-183)。
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 (Infect Control Hosp Epidemiol 2005;26:175-183).