The attributable mortality, length of stay, and health care costs of methicillin-resistant Staphylococcus aureus infections in Singapore

• Published in: IJID regions Vol. 12; p. 100427
• Main Authors: Cai, Yiying, Philip, Edwin C., Arora, Shalvi, Sim, Jean X.Y., Chow, Weien, Nazeha, Nuraini, Whiteley, Sean, Tiang, Daniel C., Neo, Siow Leng, Hong, Weiwei, Venkatachalam, Indumathi, Graves, Nicholas
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2024; Elsevier
• Subjects: Healthcare costs; Multi-state model; Nosocomial infections; Original Report; Healthcare costs; Multi-state model; Nosocomial infections
• DOI: 10.1016/j.ijregi.2024.100427
• ISSN: 2772-7076

•We used a multi-state model to determine the outcomes of methicillin-resistant Staphylococcus aureus (MRSA) infections in Singapore.•Across the MRSA types, pneumonia and bacteremia had the highest mortality risks.•MRSA infection increased the length of stay by almost 4 days compared with no MRSA.•Each MRSA infection resulted in an excess cost of Singapore dollar (SGD) $3200 from a hospital perspective. We used a multi-state model, which mitigates time-dependent bias, to estimate the mortality, length of stay (LOS), and costs of methicillin-resistant Staphylococcus aureus (MRSA) infections in Singapore. We conducted a retrospective study in a hospital in Singapore from 2018 to 2022. Patients with MRSA infections were matched 1:1:3 to patients with MRSA colonization and patients without MRSA by age, gender, specialty, and intensive care admission, respectively. A multi-state model was used to derive excess LOS and mortality hazard ratios. The attributable cost of infections was estimated in 2022 Singapore dollars (SGDs) from the health care perspective. We matched 536 patients with MRSA infections to 536 patients with MRSA colonization, and to 1608 patients without MRSA. The excess LOS due to MRSA infection was 2.11 (95% confidence interval [CI] 2.05-2.17) days compared with MRSA colonization and 3.75 (95% CI 3.69-3.80) days compared with no MRSA, which translated to an excess cost of SGD $1825 and SGD $3238, respectively. Of the different MRSA infection types, pneumonia had the highest mortality risk (hazard ratio 4.13; 95% CI 2.28-7.50) compared with patients without MRSA. MRSA infections increased hospital LOS and health care costs in Singapore. Our estimates can inform future economic analyses of management strategies against MRSA.