Are there differences in hospital cost between patients with nosocomial methicillin-resistant Staphylococcus aureus bloodstream infection and those with methicillin-susceptible S. aureus bloodstream infection?

Abstract

Objective: To examine the impact of methicillin resistance on in-hospital mortality, length of stay, and hospital cost after the onset of nosocomial Staphylococcus aureus bloodstream infection (BSI).

Design: A retrospective cohort study.

Setting: A tertiary care hospital in Rhode Island.

Patients: A cohort of 182 consecutive patients who developed nosocomial BSI due to methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA, respectively)

Results: Patients with MRSA BSI had a significantly longer total length of hospital and intensive care unit (ICU) stay before the onset of BSI and a higher average daily cost. Compared with ICU patients with MSSA BSI, those with MRSA BSI had a higher median total hospital cost ($42,137 vs $113,852), higher hospital cost after infection ($17,603 vs $51,492), and greater length of stay after infection (10.5 vs 20.5 days). After multivariable adjustment, ICU patients with MRSA BSI had significantly increased total hospital cost, hospital cost after infection, and length of stay after infection. However, using a propensity score approach, we found that, among ICU patients, the difference in cost after infection and the difference in length of stay after infection for MRSA, compared with MSSA BSI, were not significant. The differences among non-ICU patients who developed MRSA or MSSA BSI were not significant after multivariable adjustment or by propensity score.

Conclusions: On the basis of propensity score, we found that methicillin resistance did not independently increase hospital cost or length of stay after onset of S. aureus BSI. We believe that use of a propensity score on a comparable subset of patients may be a better method than multivariable adjustment for assessing the impact of methicillin resistance in cohort studies.