Skip to main content
SpringerLink
Log in

Effizientes MRSA-Management

Präventive Krankenhaushygiene unter ökonomischen Aspekten

Efficient MRSA management

Economic aspects of preventative hospital hygiene

  • Krankenhausmanagement
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Jährlich werden in deutschen Krankenhäusern etwa 132.000 Fälle von Besiedlung und Infektion durch Methicillin-resistente Staphylococcus aureus (MRSA) dokumentiert. Damit gehören MRSA zu den häufigsten multiresistenten Erregern nosokomialer Infektionen. Das Europäische Zentrum für Krankheitsprävention und Infektionskontrolle (ECDC) schätzt, dass die Kosten für MRSA die Gesundheitssysteme in der EU jedes Jahr mit 380 Millionen Euro belasten. Deshalb kommt der Prävention von MRSA eine herausragende Bedeutung zu. Trotz zunehmender Evidenz für die Wirksamkeit möglicher Präventionsansätze (Screening, Isolation, Eradikation), gerät die Frage nach deren Kosteneffizienz ebenfalls zunehmend in den Blickpunkt und ist deutlich schwieriger zu beantworten. In diesem Beitrag werden deshalb die wichtigsten Fakten zu den Kosten von MRSA-Infektionen zusammengestellt und ein Überblick über die bislang verfügbaren Daten zur Kosteneffizienz von MRSA-Präventionsmaßnahmen gegeben.

Abstract

There are 132,000 cases of colonization or infection caused by methicillin-resistant Staphylococcus aureus (MRSA) documented annually in German hospitals. Therefore, MRSA is one of the most frequent multiresistant microorganisms isolated from patients with healthcare-associated infections. Recently, the European Center for Disease Prevention and Control (ECDC) estimated that MRSA causes an attributable financial burden of 380 million EUR for the EU healthcare systems. Consequently, the prevention of MRSA is a major goal. Although there is increasing evidence supporting the effectiveness of some preventive interventions (screening, isolation, eradication) with respect to their ability to reduce MRSA, there is an on-going discussion about the cost effectiveness of these measures. In this article, financial aspects associated with MRSA are described and an overview of the current knowledge about the cost effectiveness of several key measures proposed for MRSA prevention is provided.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Jarvis WR (1996) Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 17:552–557

    Article  PubMed  CAS  Google Scholar 

  2. Wernitz MH, Keck S, Swidsinski S et al (2005) Cost analysis of a hospital-wide selective screening programme for Methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin Microbiol Infect 11:466–471

    Article  PubMed  CAS  Google Scholar 

  3. Cosgrove SE, Qi Y, Kaye KS et al (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

    Article  PubMed  Google Scholar 

  4. Whitby M, McLaws ML, Berry G (2001) Risk of death from Methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 175:264–267

    PubMed  CAS  Google Scholar 

  5. Shorr AF, Tabak YP, Gupta V et al (2006) Morbidity and cost burden of Methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia. Crit Care 10:R97

    Article  PubMed  Google Scholar 

  6. Köck R, Becker K, Cookson B et al (2010) Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 15:19688

    PubMed  Google Scholar 

  7. Muto CA, Jernigan JA, Ostrowsky BE et al (2003) SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 24:362–386

    Article  PubMed  Google Scholar 

  8. Wernitz MH, Keck S, Swidsinski S et al (2005) Cost analysis of a hospital-wide selective screening programme for Methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin Microbiol Infect 11:466–471

    Article  PubMed  CAS  Google Scholar 

  9. Papia G, Louie M, Tralla A et al (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

    Article  PubMed  CAS  Google Scholar 

  10. Jernigan JA, Clemence MA, Stott GA et al (1995) Control of Methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 16:686–696

    Article  PubMed  CAS  Google Scholar 

  11. West TE, Guerry C, Hiott M et al (2006) Effect of targeted surveillance for control of Methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 27:233–238

    Article  PubMed  Google Scholar 

  12. Gavalda L, Masuet C, Beltran J et al (2006) Comparative cost of selective screening to prevent transmission of Methicillin-resistant Staphylococcus aureus (MRSA), compared with the attributable costs of MRSA infection. Infect Control Hosp Epidemiol 27:1264–1266

    Article  PubMed  Google Scholar 

  13. 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. JAMA 282:1745–1751

    Article  PubMed  CAS  Google Scholar 

  14. Lucet JC, Chevret S, Durand-Zaleski I et al (2003) Prevalence and risk factors for carriage of Methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 163:181–188

    Article  PubMed  Google Scholar 

  15. Lee BY, Wiringa AE, Bailey RR et al (2010) Screening cardiac surgery patients for MRSA: an economic computer model. Am J Manag Care 16:e163–e173

    PubMed  Google Scholar 

  16. Herr CE, Heckrodt TH, Hofmann FA et al (2003) Additional costs for preventing the spread of Methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 24:673–678

    Article  PubMed  Google Scholar 

  17. Vriens M, Blok H, Fluit A et al (2002) Costs associated with a strict policy to eradicate Methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 21:782–786

    Article  PubMed  CAS  Google Scholar 

  18. Anonym: Anstieg bei multiresistenten Keimen verlangsamt. http://dipbundestagde/btd/16/032/1603205pdf.

  19. Hubben G, Bootsma M, Luteijn M et al (2011) Modelling the costs and effects of selective and universal hospital admission screening for Methicillin-resistant Staphylococcus aureus. PLoS One 6:e14783

    Article  PubMed  CAS  Google Scholar 

  20. Kola A, Chaberny IF, Mattner F et al (2006) Control of Methicillin-resistant S. aureus by active surveillance: Results of a workshop held by the Deutsche Gesellschaft fur Hygiene und Mikrobiologie. Anaesthesist 55:778–783

    Article  PubMed  CAS  Google Scholar 

  21. Tacconelli E, De Angelis G, Waure C de et al (2009) Rapid screening tests for meticillin-resistant Staphylococcus aureus at hospital admission: systematic review and meta-analysis. Lancet Infect Dis 9:546–554

    Article  PubMed  Google Scholar 

  22. Buhlmann M, Bogli-Stuber K, Droz S, Muhlemann K (2008) Rapid screening for carriage of Methicillin-resistant Staphylococcus aureus by PCR and associated costs. J Clin Microbiol 46:2151–2154

    Article  PubMed  Google Scholar 

  23. Lee BY, Bailey RR, Smith KJ et al (2010) Universal Methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 31:598–606

    Article  PubMed  Google Scholar 

  24. Olchanski N, Mathews C, Fusfeld L, Jarvis W (2011) Assessment of the influence of test characteristics on the clinical and cost impacts of Methicillin-resistant Staphylococcus aureus screening programs in US hospitals. Infect Control Hosp Epidemiol 32:250–257

    Article  PubMed  Google Scholar 

  25. Diller R, Sonntag AK, Mellmann A et al (2008) Evidence for cost reduction based on pre-admission MRSA screening in general surgery. Int J Hyg Environ Health 211:205–212

    Article  PubMed  Google Scholar 

  26. Cosgrove SE, Qi Y, Kaye KS et al (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

    Article  PubMed  Google Scholar 

  27. Reed SD, Friedman JY, Engemann JJ et al (2005) Costs and outcomes among hemodialysis-dependent patients with Methicillin-resistant or Methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 26:175–183

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. Ben-David D, Novikov I, Mermel LA (2009) 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? Infect Control Hosp Epidemiol 30:453–460

    Article  PubMed  Google Scholar 

  30. Shorr AF, Tabak YP, Gupta V et al (2006) Morbidity and cost burden of Methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia. Crit Care 10:R97

    Article  PubMed  Google Scholar 

  31. Robert-Koch-Institut (2011) Antibiotika Resistenz Surveillance in Deutschland. https://ars.rki.de

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Hygiene, Universitätsklinikum Münster, Robert-Koch-Str. 41, 48149, Münster, Deutschland

    F. Kipp, R. Köck & A. Mellmann

  2. Universitätsklinikum Münster, Münster, Deutschland

    N. Roeder

Authors
  1. F. Kipp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Köck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Roeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Mellmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Kipp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kipp, F., Köck, R., Roeder, N. et al. Effizientes MRSA-Management. Z Herz- Thorax- Gefäßchir 26, 63–69 (2012). https://doi.org/10.1007/s00398-011-0889-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00398-011-0889-z

Schlüsselwörter

Keywords

Search

Navigation