Although there is a growing concern and policy regarding infections or colonization caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the prognosis of MRSA infections compared to that of methicillin-susceptible Staphylococcus aureus (MSSA) infections remains controversial. Moreover, there have not been any studies comparing both the burden of disease and its impact on the healthcare economy between MRSA infection and colonization while adjusting for confounding factors. These comparisons are crucial for developing effective infection control measures and healthcare policies. We aimed to compare the disease and economic burden between MRSA and MSSA infections and between MRSA infection and colonization. We retrospectively investigated data of 496 in-patients with MRSA or MSSA infections and of 1178 in-patients with MRSA infections or MRSA colonization from a university hospital in Japan from 2016 to 2021. We compared in-hospital mortality, length of stay, and hospital charges between in-patients with MRSA and MSSA infections and those with MRSA infections and MRSA colonization using multiple regressions. We combined surveillance data, including all microbiological test results, data on patients with infections, treatment histories, and clinical outcomes, to create the datasets. There was no statistically significant difference in in-hospital mortality rates between matched MRSA vs. MSSA infections and MRSA infection vs. colonization. On the contrary, the adjusted effects of the MRSA infection compared to those of MSSA infection on length of stay and hospital charges were 1.21-fold (95% confidence interval [CI] 1.03–1.42, P = 0.019) and 1.70-fold (95% CI 1.39–2.07, P < 0.00001), respectively. The adjusted effects of the MRSA infection compared to those of MRSA colonization on length of stay and hospital charges were 1.41-fold (95% CI 1.25–1.58, P < 0.00001) and 1.53-fold (95% CI 1.33–1.75, P < 0.00001), respectively. Regarding confounding factors, hemodialysis or hemofiltration was consistently identified and adjusted for in the multiple regression analyses comparing MRSA and MSSA infections, as well as MRSA infection and MRSA colonization. MRSA infection was associated with longer length of stay and higher hospital charges than both MSSA infection and MRSA colonization. Furthermore, hemodialysis or hemofiltration was identified as a common underlying factor contributing to increased length of stay and hospital charges.

中文翻译：

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某大学医院 MRSA 感染与 MRSA 定植的疾病和经济负担比较：一项回顾性数据整合研究

尽管人们越来越关注由耐药细菌（包括耐甲氧西林金黄色葡萄球菌 (MRSA)）引起的感染或定植，并制定相应政策，但与甲氧西林敏感金黄色葡萄球菌 (MSSA) 感染相比，MRSA 感染的预后仍存在争议。此外，还没有任何研究比较 MRSA 感染和定植之间的疾病负担及其对医疗保健经济的影响，同时调整混杂因素。这些比较对于制定有效的感染控制措施和医疗保健政策至关重要。我们的目的是比较 MRSA 和 MSSA 感染之间以及 MRSA 感染和定植之间的疾病和经济负担。我们回顾性调查了 2016 年至 2021 年日本某大学医院 496 名 MRSA 或 MSSA 感染住院患者以及 1178 名 MRSA 感染或 MRSA 定植住院患者的数据。我们比较了住院死亡率、住院时间和住院时间。使用多元回归分析住院的 MRSA 和 MSSA 感染患者与 MRSA 感染和 MRSA 定植患者之间的费用。我们结合了监测数据，包括所有微生物检测结果、感染患者数据、治疗史和临床结果，以创建数据集。匹配的 MRSA 与 MSSA 感染以及 MRSA 感染与定植之间的院内死亡率没有统计学上的显着差异。相反，与 MSSA 感染相比，MRSA 感染对住院时间和住院费用的调整后影响分别为 1.21 倍（95% 置信区间 [CI] 1.03-1.42，P = 0.019）和 1.70 倍（95 % CI 1.39–2.07，P < 0.00001）。与 MRSA 定植相比，MRSA 感染对住院时间和住院费用的调整后影响分别为 1.41 倍（95% CI 1.25–1.58，P < 0.00001）和 1.53 倍（95% CI 1.33–1.75，P < 0.00001），分别。关于混杂因素，在比较 MRSA 和 MSSA 感染以及 MRSA 感染和 MRSA 定植的多元回归分析中，始终确定并调整了血液透析或血液滤过。与 MSSA 感染和 MRSA 定植相比，MRSA 感染与更长的住院时间和更高的住院费用相关。此外，血液透析或血液滤过被认为是导致住院时间和住院费用增加的常见潜在因素。