Abstract
In the UK, methicillin-resistant Staphylococcus aureus (MRSA)-associated skin and soft tissue infections (SSTIs) are predominantly managed in the hospital using intravenous (IV) glycopeptides. We set out to explore the potential for and relative healthcare costs of earlier hospital discharge through switch to oral antibiotic therapy (linezolid or rifampicin and doxycycline) or continuation of IV therapy (teicoplanin) via an outpatient parenteral antimicrobial therapy (OPAT) service. Over 16 months, 173 patients were retrospectively identified with MRSA SSTI, of whom 82.8 % were treated with IV therapy. Thirty-seven patients were potentially suitable for earlier discharge with outpatient therapy. The model assumed 3 days of inpatient management and a maximum of 14 days of outpatient therapy. For the status quo, where patients received only inpatient care with IV therapy, hospital costs were calculated at £12,316 per patient, with 97 % of costs accounted for by direct bed day costs. The mean total cost savings achievable through OPAT or oral therapy was estimated to be £6,136 and £6,159 per patient treated, respectively. A significant proportion of patients with MRSA SSTI may be suitable for outpatient management with either oral therapy or via OPAT, with the potential for significant reduction in healthcare costs.
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Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y (2005) The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26:166–174
Melzer M, Eykyn SJ, Gransden WR, Chinn S (2003) Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 37:1453–1460
Engemann JJ, Carmeli Y, Cosgrove SE et al (2003) Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36:592–598
Goetghebeur M, Landry PA, Han D, Vicente C (2007) Methicillin-resistant Staphylococcus aureus: A public health issue with economic consequences. Can J Infect Dis Med Microbiol 18:27–34
King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM (2006) Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 144:309–317
Wier LM, Henke R, Friedman B (2010) Diagnostic groups with rapidly increasing costs, by payer, 2001–2007. HCUP Statistical Brief #91. June 2010. Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. Available online at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb91.pdf
Personal correspondence Matthew Armstrong, Principle Information Analyst, NHS National Services Scotland
Gould FK, Brindle R, Chadwick PR et al (2009) Guidelines (2008) for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United Kingdom. J Antimicrob Chemother 63:849–861
Dryden M, Andrasevic AT, Bassetti M et al (2010) A European survey of antibiotic management of methicillin-resistant Staphylococcus aureus infection: current clinical opinion and practice. Clin Microbiol Infect 16(Suppl 1):3–30
Seaton RA, Sharp E, Bezlyak V, Weir CJ (2011) Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections. Int J Antimicrob Chemother 38:243–248
Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) (2011) Antimicrobial Stewardship: “Start Smart—Then Focus (formally 25). Available online at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131181.pdf
Chapman ALN, Seaton RA, Cooper MA et al (2012) Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement. J Antimicrob Chemother 67:1053–1062
Dryden M, Saeed K, Townsend R et al (2012) Antibiotic stewardship and early discharge from hospital: impact of a structured approach to antimicrobial management. J Antimicrob Chemother 67:2289–2296
Nathwani D, Morgan M, Masterton RG et al (2008) Guidelines for UK practice for the diagnosis and management of methicillin-resistant Staphylococcus aureus (MRSA) infections presenting in the community. J Antimicrob Chemother 61:976–994
Lamont E, Seaton RA, Macpherson M, Semple L, Bell E, Thomson AH (2009) Development of teicoplanin dosage guidelines for patients treated within an outpatient parenteral antibiotic therapy (OPAT) programme. J Antimicrob Chemother 64:181–187
Martone WJ, Lindfield KC, Katz DE (2008) Outpatient parenteral antibiotic therapy with daptomycin: insights from a patient registry. Int J Clin Pract 62:1183–1187
Chapman ALN, Dixon S, Andrews D, Lillie PJ, Bazaz R, Patchett JD (2009) Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective. J Antimicrob Chemother 64:1316–1324
NHS reference costs 2007–08. Available online at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_098945
Curtis L (2008) Unit costs of health and social care. Personal Social Services Research Unit, University of Kent, UK
British Medical Association and Royal Pharmaceutical Society (2010) British National Formulary 59. British Medical Journal Publishing Group and Pharmaceutical Press, London
De Cock E, Sorensen S, Levrat F et al (2009) Cost-effectiveness of linezolid versus vancomycin for hospitalized patients with complicated skin and soft-tissue infections in France. Med Mal Infect 39:330–340
Weigelt J, Itani K, Stevens D, Lau W, Dryden M, Knirsch C; Linezolid CSSTI Study Group (2005) Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother 49:2260–2266
Itani KM, Biswas P, Reisman A, Bhattacharyya H, Baruch AM (2012) Clinical efficacy of oral linezolid compared with intravenous vancomycin for the treatment of methicillin-resistant Staphylococcus aureus-complicated skin and soft tissue infections: a retrospective, propensity score-matched, case–control analysis. Clin Ther 34:1667–1673.e1
Bounthavong M, Hsu DI (2010) Efficacy and safety of linezolid in methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infection (cSSTI): a meta-analysis. Curr Med Res Opin 26:407–421
Gray A, Dryden M, Charos A (2012) Antibiotic management and early discharge from hospital: an economic analysis. J Antimicrob Chemother 67:2297–2302
Seaton RA, Bell E, Gourlay Y, Semple L (2005) Nurse-led management of uncomplicated cellulitis in the community: evaluation of a protocol incorporating intravenous ceftriaxone. J Antimicrob Chemother 55:764–767
Health Protection Scotland (2013) Quarterly report on the surveillance of Staphylococcus aureus bacteraemias in Scotland, July–September 2012. Available online at: http://www.hps.scot.nhs.uk/haiic/sshaip/wrdetail.aspx?id=53734&wrtype=9
Garau J, Bouza E, Chastre J, Gudiol F, Harbarth S (2009) Management of methicillin-resistant Staphylococcus aureus infections. Clin Microbiol Infect 15:125–136
Costs book 2009 (Scotland). Available online at: http://isdscotland.org/isd/3632.html
Acknowledgements
Provisional data were presented at the 19th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Vienna, Austria, April 2010 (poster 1337). The study was funded via an unrestricted educational grant from Pfizer, UK. Technical support in the data collection and analysis was provided by pH Associates Ltd. Thanks go to Professor R. Masterton for contributions to the initial study design and helpful advice on the manuscript.
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RAS has received honoraria for speaking and for advisory work for Pfizer, Novartis, MSD, AstraZeneca and Astellas. No fee was received for the preparation of this manuscript.
SJ was a paid consultant for Pfizer, UK.
JEC has received honoraria for speaking and for advisory work for Pfizer and Astellas. No fee was received for the preparation of this manuscript.
NR has no interests to declare and no fee was received for the preparation or review of this manuscript.
SC is an employee of pH Associates and no fee was received for the preparation or review of this manuscript.
BLJ has received honoraria for speaking and for advisory work for Pfizer, Gilead, MSD, AstraZeneca and Astellas. He owns stock in Pfizer, Gilead and MSD. No fee was received for the preparation of this manuscript.
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Seaton, R.A., Johal, S., Coia, J.E. et al. Economic evaluation of treatment for MRSA complicated skin and soft tissue infections in Glasgow hospitals. Eur J Clin Microbiol Infect Dis 33, 305–311 (2014). https://doi.org/10.1007/s10096-013-1956-z
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DOI: https://doi.org/10.1007/s10096-013-1956-z