Costs and Complications of Hospitalization among Survivors of S. aureusbacteremia in the US: A Multicenter Retrospective Cohort Study, 2020-2022
Author(s)
Marya Zilberberg, MD, MPH1, Brian H. Nathanson, PhD2, Rolf Wagenaar, MS3, Jan Posthumus, MBA, PhD4, Andrew Shorr, MD, MPH, MBA, MA5.
1EviMed Research Group, LLC, Goshen, MA, USA, 2OptiStatim, LLC, Longmeadow, MA, USA, 3Basilea Pharmaceutica International Ltd, Allschwil, Switzerland, 43Basilea Pharmaceutica International Ltd, Allschwil, Switzerland, 5Washington Hospital Center, Washington, DC, USA.
1EviMed Research Group, LLC, Goshen, MA, USA, 2OptiStatim, LLC, Longmeadow, MA, USA, 3Basilea Pharmaceutica International Ltd, Allschwil, Switzerland, 43Basilea Pharmaceutica International Ltd, Allschwil, Switzerland, 5Washington Hospital Center, Washington, DC, USA.
Presentation Documents
OBJECTIVES: Patients with S. aureus (SA) infection comprise nearly 1% of all hospitalizations in the US and incur 3x the length of stay (LOS) and hospital costs of those without this infection. SA bacteremia (SAB) in particular is common, with an incidence approaching 50 cases/100,000 population. While mortality and rehospitalization rates for SAB have been well studied, the incidence and costs associated with other complications arising during SAB hospitalizations remain unclear.
METHODS: To determine index SAB hospitalization-associated complication (C+) rates and costs, we analyzed outcomes for adult patients in a US database (~300 hospitals, 2020-2022) who survived an index hospitalization with >/=1 positive blood culture (BC) for S. aureus. We defined complications as >/=1 of the following: antibiotic escalation; persistently positive blood culture (BC); incident vasopressors, ICU, mechanical ventilation (MV), or dialysis; prolonged post-infection LOS [defined as LOS> median LOS]; or readmission within 30 days after discharge. We used descriptive statistics to compare patients C+ to C-.
RESULTS: Among 3,956 surviving patients, 2,303 (58.2%) had C+ during their index SAB hospitalization. In both groups, the majority of SABs were community-onset (86.9% C+ vs. 85.7% C-, p=0.251), while patients with C+ more commonly than C- suffered from methicillin-resistant SA (44.3% vs. 33.7%, p<0.001). The most common complication was 30-day readmission (42.0%), followed by: antimicrobial escalation (38.6%); vasopressor use (32.4%); prolonged LOS (20.3%); dialysis (10.6%); ICU admission (10.0%); MV (5.0%); and persistent BC+ (3.9%). The mean [SD] post-infection onset LOS (15.7 [14.4] vs. 9.2 [3.7] days) and hospital costs ($37,468 [$56,973] vs. $18,371 [$11,249]) were higher in C+ vs the C- cohort (p<0.001 for both).
CONCLUSIONS: Complications occur frequently in hospitalized patients with SABs. They result in excessive costs and contribute to a considerable strain on hospital resources. Further research needs to explore elements of management that may reduce this burden.
METHODS: To determine index SAB hospitalization-associated complication (C+) rates and costs, we analyzed outcomes for adult patients in a US database (~300 hospitals, 2020-2022) who survived an index hospitalization with >/=1 positive blood culture (BC) for S. aureus. We defined complications as >/=1 of the following: antibiotic escalation; persistently positive blood culture (BC); incident vasopressors, ICU, mechanical ventilation (MV), or dialysis; prolonged post-infection LOS [defined as LOS> median LOS]; or readmission within 30 days after discharge. We used descriptive statistics to compare patients C+ to C-.
RESULTS: Among 3,956 surviving patients, 2,303 (58.2%) had C+ during their index SAB hospitalization. In both groups, the majority of SABs were community-onset (86.9% C+ vs. 85.7% C-, p=0.251), while patients with C+ more commonly than C- suffered from methicillin-resistant SA (44.3% vs. 33.7%, p<0.001). The most common complication was 30-day readmission (42.0%), followed by: antimicrobial escalation (38.6%); vasopressor use (32.4%); prolonged LOS (20.3%); dialysis (10.6%); ICU admission (10.0%); MV (5.0%); and persistent BC+ (3.9%). The mean [SD] post-infection onset LOS (15.7 [14.4] vs. 9.2 [3.7] days) and hospital costs ($37,468 [$56,973] vs. $18,371 [$11,249]) were higher in C+ vs the C- cohort (p<0.001 for both).
CONCLUSIONS: Complications occur frequently in hospitalized patients with SABs. They result in excessive costs and contribute to a considerable strain on hospital resources. Further research needs to explore elements of management that may reduce this burden.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO111
Topic
Clinical Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine)