Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with high rates of morbidity and mortality. Vancomycin remains widely used to treat MRSA pneumonia and bacteremia despite documented treatment failure rates reported in the literature between 21% and 50%. Given these substantial failure rates, it is plausible that vancomycin treatment failures contribute a meaningful economic burden to hospitals.
The authors aimed to estimate hospital costs for patients treated with vancomycin for MRSA pneumonia and/or bacteremia and to compare costs between patients who experienced treatment failure and those who experienced treatment success.
This was a retrospective cohort study of patients admitted to a Canadian hospital from 2014 to 2018 with MRSA pneumonia and/or bacteremia who received vancomycin. Direct and indirect hospital costs and additional clinical data were extracted from the hospital database. All costs were adjusted to 2024 Canadian dollars using the Consumer Price Index.
A generalized linear model was used to estimate the adjusted difference in hospital costs between patients with and without treatment failure. The abstract reports cohort size and the analytic approach; detailed model covariates, the exact link function and distribution used in the generalized linear model, and full cost component breakdowns were not described in the source text provided.
A total of 128 patients met inclusion criteria. Of these, 43 patients (34%) were identified as having treatment failure while the remainder were categorized as treatment successes.
Compared with patients who achieved treatment success, those with treatment failure had clinically worse courses as summarized in the abstract: higher rates of vasopressor use, increased need for intensive care, higher Sequential Organ Failure Assessment (SOFA) scores, more frequent requirement for mechanical ventilation, and higher rates of nephrotoxicity. The abstract does not provide additional numeric breakdowns for each of these clinical variables in the source text provided.
Treatment failure was associated with significantly higher hospital costs than treatment success. The generalized linear model estimated an adjusted mean difference in total hospital cost of $43,082 (95% confidence interval $2,065 to $84,098), expressed in 2024 Canadian dollars.
The study thus found a robust association between vancomycin treatment failure for MRSA pneumonia and/or bacteremia and increased hospital resource use as reflected in total costs. The abstract does not provide the unadjusted cost means, medians, or the distribution of specific cost categories (for example, intensive care unit costs, pharmacy costs, or procedure-related costs) in the text provided.
The observed association between treatment failure and higher costs aligns with the reported greater intensity of care among failures: increased vasopressor use, more frequent ICU admission, higher SOFA scores, need for mechanical ventilation, and nephrotoxicity would be expected to raise both direct and indirect hospital costs. These findings underscore that antimicrobial treatment effectiveness has implications beyond clinical outcomes, extending to hospital budgets and potentially to system-level resource allocation.
Clinicians and hospital administrators should be aware that inadequate initial response to vancomycin in MRSA pneumonia or bacteremia may lead to more intensive supportive care and higher costs. This could inform antimicrobial stewardship discussions, early evaluation of therapeutic response, and considerations about alternative therapies or earlier escalation in selected cases. The authors do not make specific treatment recommendations in the abstract.
The abstract reports key outcomes but omits several details that would inform interpretation and potential generalizability. Specifically, the source text provided did not report:
Because these details were not reported in the source abstract provided, readers should consult the full article for granular methodological and results information before applying the findings to other settings.
In this retrospective cohort of 128 patients treated with vancomycin for MRSA pneumonia and/or bacteremia, treatment failure occurred in 34% of patients and was associated with significantly higher hospital costs. The adjusted mean difference in total hospital cost for patients with treatment failure was $43,082 (95% CI $2,065 to $84,098) in 2024 Canadian dollars. Patients with failure also had more intensive clinical courses (higher vasopressor use, ICU needs, SOFA scores, mechanical ventilation, and nephrotoxicity). The authors conclude that failure of vancomycin treatment for MRSA pneumonia and/or bacteremia substantially increased hospital costs.
Conflict of interest: None declared according to the source abstract.
For additional methodological detail, exact covariates, and cost component breakdowns, consult the full published article referenced by PMID 42699834 and DOI 10.4212/cjhp.3860.