421. Costs and outcomes for children with methicillin-sensitive Staphylococcus aureus osteoarticular infections with bacteremia
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • Nuibe - 421_IDWeek Poster - Revised 9.25.13.pdf (372.7 kB)
  • Background: Methicillin-sensitive Staphylococcus aureus (MSSA) is a common cause of acute osteoarticular infections in children.  However, little is known about factors associated with prolonged hospitalization, complications, and costs of different treatment regimens for this disease.  We sought to evaluate measures of care process and outcomes for MSSA osteoarticular infections with bacteremia in order to identify opportunities to improve the quality and cost of care.

    Methods: The Intermountain Enterprise Data Warehouse (EDW) was queried to identify patients with MSSA osteoarticular infections with confirmed bacteremia, admitted to Primary Children’s Medical Center (PCMC) from January 1, 2008 to December 31, 2012.  Patients were identified by ICD-9 codes.  Care process measures included use of echocardiograms, antibiotic regimens, and antibiotic costs per PCMC pharmacy database.  Outcome measures included length of stay (LOS), bacteremia duration, surgical interventions, and diagnosis of endocarditis.  Data were analyzed by Mann-Whitney tests.   

    Results: 86 patients were identified.  The median overall hospital cost was $14,500 ($6,800-104,000).  Nafcillin, cefazolin, and clindamycin were the most common antibiotics used, and were often given in various combinations.  Antibiotic regimens which included nafcillin (n=75) had a median LOS of 6 days, median bacteremia duration of 39 hours, and median total antibiotic cost of $246 ($41/day).  Non-nafcillin regimens (n=11) had a median LOS of 5 days, median bacteremia duration of 33 hours, and median total antibiotic cost of $53 ($11/day).  67% of patients underwent surgical procedure, and the median number of surgeries in both groups was 1.  47% of patients had echocardiograms; none confirmed endocarditis.  There was a significant difference in costs between nafcillin-based and non-nafcillin regimens (p-value < 0.0005) while there was no significant differences in LOS, bacteremia duration, or number of surgeries based on the antibiotic regimen used.         

    Conclusion: Non-nafcillin regimens had four-fold lower costs compared to nafcillin-based regimens.  Greater use of cefazolin or clindamycin and more judicious use of echocardiograms in MSSA osteoarticular infections with bacteremia could substantially reduce costs.

    Andrew Nuibe, MD1, Jared Olson, PharmD2, Adam L. Hersh, MD, PhD1, Chris Stockmann, MSc1, Susan K. Sanderson, DNP1, Andrew Pavia, MD, FIDSA, FSHEA1 and Emily A. Thorell, MD, MSci1, (1)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (2)Primary Children's Medical Center, Salt Lake City, UT


    A. Nuibe, None

    J. Olson, None

    A. L. Hersh, None

    C. Stockmann, None

    S. K. Sanderson, None

    A. Pavia, None

    E. A. Thorell, None

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