Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?

OBJECTIVE: To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) primary bloodstream infections (BSIs).
DESIGN: Pairwise-matched (1:1) nested case-control study.
SETTING: University-based tertiary-care medical center. PATIENTS: Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomial S. aureus BSI; controls were selected according to a priori matching criteria. MEASUREMENTS: Length of hospital stay and total and variable direct costs of hospitalization.
RESULTS: The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).
CONCLUSION: Nosocomial primary BSI due to S. aureus significantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.