Economic consequences of the demography of MRSA patients and the impact of broad-spectrum antimicrobials

BACKGROUND

Studies have determined the societal impact of methicillin-resistant Staphylococcus aureus (MRSA) by modelling its impact on labour supply and productivity. In addition, most of the studies on the topic conclude that the problem of resistance should be counteracted on the macro level by reducing overall antibacterial consumption.

OBJECTIVE

Two major questions have been raised in the present work. Firstly, is MRSA impairing labour supply and productivity? Secondly, is it the overall use of antibacterials that may be seen as crucial to the spread of MRSA infections?

METHODS

The age distribution of MRSA patients is compared with the age distribution of the entire patient population at a German teaching hospital. In addition, the age distribution of MRSA patients was applied to the age distribution of the German population in the year 2050 in order to identify the effects of the double-ageing process on the spread of MRSA. Furthermore, recent epidemiological studies were reviewed on the impact of overall antibacterial consumption on MRSA infection rates.

RESULTS

Based on available data, we show that patients infected or colonized with MRSA are, for the most part, beyond retirement age and thus not responsible for changes in labour supply or productivity. Application of age distribution of MRSA patients to the age distribution of the German population in the year 2050 gives a 24% increase in the number of MRSA cases to a total of 182 778 due to an ageing population. In addition, we show that a 32% reduction in the cost of MRSA to the German healthcare system could be reached if use of fluoroquinolones and third-generation cephalosporins was reduced by just 10% and, correspondingly, use of antiseptics for hand disinfection was increased by 10%.

CONCLUSIONS

MRSA is a phenomenon that, to a larger degree, affects the elderly population rather than the labour force. When it comes to policy options to counteract MRSA on the macro level, most economic research on the topic is biased in assuming that the overall use of antibacterials is responsible for the spread of MRSA infections.

Economic implications of the dynamic relationship between antibiotic use and hospital-acquired infections

OBJECTIVES

The emergence and spread of antimicrobial resistance is still an unresolved problem worldwide. Recent evidence shows correlations between the volume of broad-spectrum antibiotics used in the hospital setting and the incidence of multidrug-resistant bacteria. According to this dynamic relationship, loss of antibiotic activity can be modeled as a negative externality of antibiotic consumption.

METHODS

The present study proposes to present an economic model describing the probability of antibiotic treatment failure as a function of antimicrobial use and alcohol-based hand-rub use. Furthermore, the results of recently conducted time-series analyses and cost-of-illness studies are applied to the model to determine the externalities of antibiotic consumption and alcohol-based hand-rub use with respect to the costs of hospital-acquired infections.

RESULTS

According to our calculations, the consumption of third-generation cephalosporins and fluoroquinolones is associated with the highest negative externalities (€143 and €101, respectively) because their use has been shown to be associated with most types of hospital-acquired infections. In contrast, the use of alcohol-based hand-rub solution for hand disinfection is associated with a positive externality of 41 cents per single disinfection of the hands.

CONCLUSIONS

The externalities presented in this work represent a possible application of cost-of-illness data to quantify the impact of antibiotic use on antimicrobial resistance. In addition, the results indicate that most economic research on the topic is biased in assuming the overall use of antibiotics to be responsible for the spread of antimicrobial resistance.

Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards

INTRODUCTION

Healthcare-associated infections cost the UK National Health Service 1 billion UK pounds per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance.

SUBJECTS AND METHODS

Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance. Footage was reviewed to monitor compliance of all persons entering the ward over a 12-month period.

RESULTS

For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P < 0.0001). Compliance improved for all persons entering the ward as follows (before - after, significance): doctors (0% - 54%, P < 0.01); nurses (24% - 75%, P < 0.05); porters (21% - 67%, P < 0.05); visitors (35% - 68%, P < 0.01); patients (23% - 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ.

CONCLUSIONS

This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.

Measuring the externality of antibacterial use from promoting antimicrobial resistance

BACKGROUND

The emergence and spread of antimicrobial resistance (AMR) has become a serious public health threat. Rational antibacterial policy, combined with enforcement of infection control practices are key strategies to combat AMR in the hospital setting. Loss of antibacterial activity as a direct result of antibacterial consumption can be modelled via the economic approach of a negative externality.

OBJECTIVE

To determine the externalities of antibacterial consumption and alcohol-based hand rub use for hand disinfection.

METHODS

A simple model was built, combining the results of a recently conducted cost-of-illness study with the results of a multivariate time-series analysis, which determined the impact of antibacterial consumption and alcohol-based hand rub use on the incidence of hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA).

RESULTS

Consumption of a single defined daily dose of second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and lincosamides is associated with a negative externality of about €5, €15, €11 and €12, respectively. In contrast, use of 1 litre of alcohol-based hand rub solution for hand disinfection is associated with a positive externality of about €61. In other words, a single disinfection of the hands (use of 3 mL alcohol-based hand rub solution) saves an average €0.18 of the potential cost incurred by MRSA-related infections.

CONCLUSIONS

Quantifying the externalities of antibacterial use and alcohol-based hand rub use may lead to changes in prescribing behaviour and increase compliance with hand disinfection. Furthermore, the presented methodology of relating the cost of resistance to specific factors such as antibacterial use and hand disinfection provides information that may be useful for prioritizing prevention methods.