Cost-savings achieved by eradication of epidemic methicillin-resistant Staphylococcus aureus (EMRSA)-16 from a large teaching hospital


Methicillin-resistant Staphylococcus aureus continues to be an increasing problem worldwide, although its prevalence in the Nordic countries still is low. In 1997 an unusually readily transmissible strain of epidemic methicillin-resistant S. aureus, EMRSA-16, was introduced by a single patient into a 2,600 bed teaching hospital in Sweden. Despite the standard “search and destroy” policy (Standard MRSA Control Programme), the outbreak took on epidemic proportions. Therefore, the hospital management chose to implement vigorous and costly actions (Intensive MRSA Control Programme). These measures were successful, and the strain was completely eradicated. Whether the actions taken were cost-effective was analysed using an analytical framework in which different scenarios were simulated (decision analytic modelling). Thus, the relative costs and consequences of the Standard MRSA Control Programme and the Intensive MRSA Control Programme could be compared in a simple manner. Coefficients were developed from the observations of the transmission of the bacteria during the period preceding the study period. These were then used to simulate the outcome of the alternative programmes. The uncertainty of the results was explored in sensitivity analyses. The Intensive MRSA Control Programme was shown to be cost saving after slightly more than 24 months of implementation. In conclusion, due to vigorous control efforts, a large EMRSA-16 outbreak in a university hospital was stopped. The initial costs of the control programme were high, but future healthcare resources were saved.

This is a preview of subscription content, log in to check access.


  1. 1.

    Rao N, Jacobs S, Joyce L (1988) Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 9:255–260

    CAS  PubMed  Google Scholar 

  2. 2.

    Barrett F, McGehee RF Jr, Finland M (1968) Methicillin-resistant Staphylococcus aureus at Boston city hospital. Bacteriologic and epidemiologic observations. N Engl J Med 279:441–448

    CAS  PubMed  Google Scholar 

  3. 3.

    Turnidge J, Lawson P, Munro R, Benn R (1989) A national survey of antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals. Med J Aust 150:65–72

    CAS  PubMed  Google Scholar 

  4. 4.

    Panlilio A, Culver D, Gaynes R, Banerjee S, Henderson T, Tolson JS, Martone W (1992) Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975–1991. Infect Control Hosp Epidemiol 13:582–586

    CAS  PubMed  Google Scholar 

  5. 5.

    Adeyemi-Doro FAB, Scheel O, Lyon DJ, Cheng AFB (1997) Living with methicillin-resistant Staphylococcus aureus: a 7-year experience with endemic MRSA in a university hospital. Infect Control Hosp Epidemiol 18:765–767

    CAS  PubMed  Google Scholar 

  6. 6.

    Durmaz B, Durmaz R, Sahin K (1997) Methicillin resistance among Turkish isolates of Staphylococcus aureus strains from nosocomial and community infections and their resistance patterns using various antimicrobial agents. J Hosp Infect 37:325–329

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Adcock PM, Pastor P, Medley F, Patterson JE, Murphy TV (1998) Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 178:577–580

    CAS  PubMed  Google Scholar 

  8. 8.

    Maguire GP, Arthur AD, Boustead PJ, Dwyer B, Currie BJ (1998) Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 38:273–281

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    The European Antimicrobial Resistance Surveillance System (EARSS) (2001) Surveillance report. EARSS activities and results: update.

  10. 10.

    Vandenbroucke-Grauls C (1994) Epidemiology of staphylococcal infections—a European perspective. J Chemother 6:67–70

    Google Scholar 

  11. 11.

    Boyce JM (1995) Strategies for controlling methicillin-resistant Staphylococcus aureus in hospitals. J Chemother 7:81–85

    Google Scholar 

  12. 12.

    Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, Duckworth GJ, Lai R, Ebrahim S (2003) Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assess 7:33–51, 79–81

    Google Scholar 

  13. 13.

    Teare E, Barrett S (1997) Is it time to stop searching for MRSA? Stop the ritual of tracing colonised people. Br Med J 314:665–666

    CAS  Google Scholar 

  14. 14.

    Lacey RW (1987) Multi-resistant Staphylococcus aureus—a suitable case for inactivity? J Hosp Infect 9:103–105

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Jernigan J, Clemence M, Stott G, Titus M, Alexander C, Palumbo C, Farr B (1995) Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 16:686–696

    CAS  PubMed  Google Scholar 

  16. 16.

    Papia G, Louie M, Tralla A, Johnson C, Collins V, Simor AE (1999) Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 20:473–477

    CAS  PubMed  Google Scholar 

  17. 17.

    Chaix C, Durand-Zaleski I, Alberti C, Brun-Buisson C (1999) Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. J Am Med Assoc 282:1745–1751

    Article  CAS  Google Scholar 

  18. 18.

    Richardson W, Detsky AS (1995) Users’ guides to the medical literature. VII. How to use a clinical decision analysis. A. Are results of the study valid? J Am Med Assoc 273:1292–1295

    Article  CAS  Google Scholar 

  19. 19.

    Richardson W, Detsky AS (1995) Users’ guides to the medical literature. VII. How to use a clinical decision analysis. B. What are the results and will they help me in caring for my patients? J Am Med Assoc 273:1610–1613

    Article  CAS  Google Scholar 

  20. 20.

    Barr JT, Schumacher GE (1996) Using decision analysis to conduct pharmacoeconomic studies. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven, Philadelphia, pp 1197–1214

    Google Scholar 

  21. 21.

    Detsky AS, Naglie G, Krahn MD, Naimark D, Redelmeier DA (1997) Primer on medical decision analysis. Part 1. Getting started. Med Decis Making 17:123–125

    CAS  PubMed  Google Scholar 

  22. 22.

    Sculpher M, Fenwick E, Claxton K (2000) Assessing quality in decision analytic cost-effectiveness models: a suggested framework and example of application. Pharmacoeconomics 17:461–477

    CAS  PubMed  Google Scholar 

  23. 23.

    Anonymous (1993) EMRSA-16: a new epidemic strain of Staphylococcus aureus. Commun Dis Rep Wkly 3(6):25

    Google Scholar 

  24. 24.

    Anonymous (1993) The spread of EMRSA-16. Commun Dis Rep Wkly 3(27):121

    Google Scholar 

  25. 25.

    Cox RA, Conquest C, Mallaghan C, Marples RR (1995) A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 29:87–106

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Briggs A, Sculpher M, Buxton M (1994) Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 3:95–104

    CAS  PubMed  Google Scholar 

  27. 27.

    Casewell MW (1995) New threats to the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 30:465–471

    Article  PubMed  Google Scholar 

  28. 28.

    Austin DJ, Anderson RM (1999) Transmission dynamics of epidemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in England and Wales. J Infect Dis 179:883–891

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Hori S, Sunley R, Tami A, Grundmann H (2002) The Nottingham Staphylococcus aureus population study: prevalence of MRSA among the elderly in a university hospital. J Hosp Infect 50:25–29

    Article  CAS  PubMed  Google Scholar 

Download references


We wish to express our gratitude to Prof. Bengt Jönsson, Stockholm School of Economics, Sweden, for his support regarding the health economic aspects of this study. We are also grateful for the assistance of the following persons from Sahlgrenska University Hospital in Gothenburg: Leif Larsson, Department of Hospital Infection Control, for information about the transmission of EMRSA-16 within the hospital; Torsten Sandberg, MD, PhD, Department of Infectious Diseases, for supplying information on the care of the EMRSA-16 patients, and Leif Sundberg, Department of Economics, for help in identifying the costs of the outbreak. The study was performed in accordance with the current laws of Sweden.

Author information



Corresponding author

Correspondence to I. Björholt.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Björholt, I., Haglind, E. Cost-savings achieved by eradication of epidemic methicillin-resistant Staphylococcus aureus (EMRSA)-16 from a large teaching hospital. Eur J Clin Microbiol Infect Dis 23, 688–695 (2004).

Download citation


  • Hand Hygiene
  • Reference Period
  • Hospital Infection Control
  • Communicable Disease Control
  • Cohort Care