---
title: "Hospital Costs of Vancomycin Failure for MRSA Pneumonia and Bacteremia"
id: "pubmed-42699834"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42699834"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42699834/"
doi: "10.4212/cjhp.3860"
published_at: "2026-09-09T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Hospital Costs of Vancomycin Failure for MRSA Pneumonia and Bacteremia
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42699834
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42699834/)
- **DOI:** [10.4212/cjhp.3860](https://doi.org/10.4212%2Fcjhp.3860)
- **Published At:** 2026-09-09T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Methicillin-resistant Staphylococcus aureus (**MRSA**) infections cause substantial morbidity and mortality; **vancomycin** is commonly used for MRSA pneumonia and bacteremia despite high reported failure rates (21–50%). - The study is a retrospective cohort of 128 patients admitted to a Canadian hospital (2014–2018) who received vancomycin for MRSA pneumonia and/or bacteremia. - Treatment failure occurred in 43 patients (34%) in the cohort. - Costs (direct and indirect hospital costs) were obtained from the hospital database and inflated to 2024 Canadian dollars using the Consumer Price Index. - A generalized linear model estimated the adjusted difference in hospital costs between patients with and without treatment failure. - Treatment failure was associated with a significantly higher adjusted mean total hospital cost: an adjusted mean difference of **$43,082** (95% CI $2,065 to $84,098). - Patients with failure had higher rates of vasopressor use, greater need for intensive care, higher Sequential Organ Failure Assessment (**SOFA**) scores, more frequent mechanical ventilation, and higher rates of nephrotoxicity. - The authors conclude that failure of vancomycin treatment for MRSA pneumonia and/or bacteremia significantly increased hospital costs. - Conflict of interest: None declared. Specific methodological details such as case definitions for treatment failure, comorbidity adjustments, or breakdown of cost categories were reported only as described in the abstract and main results; further granular data were not reported in the source text provided.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 , PhD, PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 2 , PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 3 , BScPharm, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 4 , PharmD, is with the Department of Pharmacy, Unity Health Toronto, Toronto, Ontario. * 5 , PhD, is with the Ottawa Hospital Research Institute, The Ottawa Hospital, and the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario. * 6 , PharmD, is with the Department of Pharmacy and the Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario. * PMID: **42699834** * PMCID: **PMC13544585** (available on 2027-03-09) * DOI: [ 10.4212/cjhp.3860 ](https://doi.org/10.4212/cjhp.3860) Item in Clipboard # Costs Associated with Failure of Vancomycin Treatment for Pneumonia and Bacteremia Due to Methicillin-Resistant _Staphylococcus aureus_ Maria Josey et al. Can J Hosp Pharm. 2026. Show details Display options Display options Format Abstract PubMed PMID Can J Hosp Pharm Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Can+J+Hosp+Pharm%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Can+J+Hosp+Pharm%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42699834/) . 2026 Sep 9;79(3):e3860. doi: 10.4212/cjhp.3860. eCollection 2026. ### Authors [Maria Josey](https://pubmed.ncbi.nlm.nih.gov/?term=Josey+M&cauthor_id=42699834)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-1 ", PhD, PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario."), [Ryan Marko](https://pubmed.ncbi.nlm.nih.gov/?term=Marko+R&cauthor_id=42699834)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-2 ", PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario."), [Jérémie Gauthier](https://pubmed.ncbi.nlm.nih.gov/?term=Gauthier+J&cauthor_id=42699834)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-3 ", BScPharm, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario."), [Letissia Fadel](https://pubmed.ncbi.nlm.nih.gov/?term=Fadel+L&cauthor_id=42699834)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-4 ", PharmD, is with the Department of Pharmacy, Unity Health Toronto, Toronto, Ontario."), [Kednapa Thavorn](https://pubmed.ncbi.nlm.nih.gov/?term=Thavorn+K&cauthor_id=42699834)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-5 ", PhD, is with the Ottawa Hospital Research Institute, The Ottawa Hospital, and the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario."), [Salmaan Kanji](https://pubmed.ncbi.nlm.nih.gov/?term=Kanji+S&cauthor_id=42699834)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42699834/#short-view-affiliation-6 ", PharmD, is with the Department of Pharmacy and the Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario.") ### Affiliations * 1 , PhD, PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 2 , PharmD, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 3 , BScPharm, is with the Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario. * 4 , PharmD, is with the Department of Pharmacy, Unity Health Toronto, Toronto, Ontario. * 5 , PhD, is with the Ottawa Hospital Research Institute, The Ottawa Hospital, and the School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario. * 6 , PharmD, is with the Department of Pharmacy and the Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario. * PMID: **42699834** * PMCID: **PMC13544585** (available on 2027-03-09) * DOI: [ 10.4212/cjhp.3860 ](https://doi.org/10.4212/cjhp.3860) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42699834/#eng-abstract) [ French ](https://pubmed.ncbi.nlm.nih.gov/42699834/#fra-abstract) **Background:** Methicillin-resistant _Staphylococcus aureus_ (MRSA) infections are associated with high rates of mortality and morbidity. Vancomycin is widely used for the treatment of pneumonia and bacteremia due to MRSA, despite treatment failure rates between 21% and 50%. Given the high rates of treatment failure with vancomycin, it is hypothesized that such failure may add a substantial burden to the health care system. **Objectives:** To estimate the hospital costs for patients treated with vancomycin for MRSA pneumonia and/or bacteremia, comparing costs between those who experienced treatment failure and those who experienced treatment success. **Methods:** This retrospective cohort study involved patients admitted to a Canadian hospital between 2014 and 2018 with MRSA pneumonia and/or bacteremia who were treated with vancomycin. Direct and indirect hospital costs and additional clinical data were obtained from the hospital database. All costs were inflated 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. **Results:** A total of 128 patients were included in the cohort, of whom 43 (34%) were identified as having treatment failure. Treatment failure was associated with significantly higher costs than treatment success, with an adjusted mean difference in total cost of $43 082 (95% confidence interval $2065 to $84 098). Those with treatment failure had higher rates of vasopressor use, greater need for intensive care, higher sequential organ failure assessment scores, greater need for mechanical ventilation, and higher rates of nephrotoxicity. **Conclusions:** Failure of vancomycin treatment for MRSA pneumonia and/or bacteremia significantly increased hospital costs. **Contexte:** Les infections à _Staphylococcus aureus_ résistant à la méticilline (SARM) sont associées à des taux élevés de mortalité et de morbidité. La vancomycine est largement utilisée pour le traitement des pneumonies et des bactériémies à SARM, malgré des taux d’échec thérapeutique compris entre 21 % et 50 %. Étant donné les taux élevés d’échec thérapeutique par la vancomycine, l’hypothèse est émise que ces échecs pourraient constituer une charge importante pour le système de santé. **Objectifs:** Estimer les coûts hospitaliers associés aux patients traités par vancomycine pour une pneumonie ou une bactériémie à SARM, en comparant les coûts associés aux patients dont le traitement a fonctionné et ceux chez qui il n’a pas fonctionné. **Méthodologie:** Cette étude de cohorte rétrospective incluait des patients admis dans un hôpital canadien entre 2014 et 2018 qui étaient atteints de pneumonie ou de bactériémie à SARM et qui étaient traités par vancomycine. Les coûts hospitaliers directs et indirects ainsi que des données cliniques supplémentaires ont été obtenus à partir de la base de données hospitalière. Tous les coûts ont été exprimés en dollars canadiens de 2024 en utilisant l’indice des prix à la consommation. Un modèle linéaire généralisé a été utilisé afin d’estimer la différence ajustée des coûts hospitaliers entre les patients avec et sans échec thérapeutique. **Résultats:** Au total, 128 patients ont été inclus dans la cohorte, dont 43 (34 %) ont connu un échec thérapeutique. Celui-ci était associé à des coûts significativement plus élevés qu’en cas de réussite du traitement, avec une différence moyenne ajustée du coût total de 43 082 $ (intervalle de confiance à 95 %: 2065 $ – 84 098 $). Les taux de recours plus élevés aux vasopresseurs et aux soins intensifs, des scores plus élevés sur l’échelle SOFA (Sequential Organ Failure Assessment, un outil médical qui sert à évaluer et suivre la gravité de la défaillance des organes), un recours plus fréquent à la ventilation mécanique, ainsi que des taux plus élevés de néphrotoxicité ont été observés chez les patients ayant connu un échec thérapeutique. **Conclusions:** L’échec du traitement par vancomycine dans les cas de pneumonie ou de bactériémie à SARM entraînait une augmentation significative des coûts hospitaliers. **Keywords:** MRSA bacteremia; MRSA pneumonia; Mots-clés :Staphylococcus aureus résistant à la méticilline (SARM); analyse pharmacoéconomique; bactériémie à SARM; coûts hospitaliers; hospital costs; methicillin-resistant Staphylococcus aureus (MRSA); pharmacoeconomic analysis; pneumonie à SARM; treatment failure; échec thérapeutique. © 2026 Canadian Society of Healthcare-Systems Pharmacy | Société canadienne de pharmacie dans les réseaux de la santé. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Competing interests: None declared. ## Similar articles * [ Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model. ](https://pubmed.ncbi.nlm.nih.gov/20550222/) Brown J, Paladino JA.Brown J, et al.Pharmacoeconomics. 2010;28(7):567-75. doi: 10.2165/11533020-000000000-00000.Pharmacoeconomics. 2010.PMID: 20550222 * [ Nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus treated with linezolid or vancomycin: A secondary economic analysis of resource use from a Spanish perspective. ](https://pubmed.ncbi.nlm.nih.gov/27061776/) Rello J, Nieto M, Solé-Violán J, Wan Y, Gao X, Solem CT, De Salas-Cansado M, Mesa F, Charbonneau C, Chastre J.Rello J, et al.Med Intensiva. 2016 Nov;40(8):474-482. doi: 10.1016/j.medin.2016.01.007. Epub 2016 Apr 6.Med Intensiva. 2016.PMID: 27061776English, Spanish. * [ Outcomes and costs associated with a history of vancomycin exposure in patients with MRSA-related complicated bacteremia and infective endocarditis. ](https://pubmed.ncbi.nlm.nih.gov/21925733/) Brown J, Brown KA, Forrest A.Brown J, et al.Clin Ther. 2011 Oct;33(10):1475-82. doi: 10.1016/j.clinthera.2011.08.011. Epub 2011 Sep 16.Clin Ther. 2011.PMID: 21925733 * [ Methicillin-resistant Staphylococcus aureus nosocomial pneumonia: role of linezolid in the People's Republic of China. ](https://pubmed.ncbi.nlm.nih.gov/27069370/) Lesher B, Gao X, Chen Y, Liu Z.Lesher B, et al.Clinicoecon Outcomes Res. 2016 Mar 24;8:63-72. doi: 10.2147/CEOR.S91985. eCollection 2016.Clinicoecon Outcomes Res. 2016.PMID: 27069370Free PMC article.Review. * [ European perspective and update on the management of nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. ](https://pubmed.ncbi.nlm.nih.gov/24580739/) Chastre J, Blasi F, Masterton RG, Rello J, Torres A, Welte T.Chastre J, et al.Clin Microbiol Infect. 2014 Apr;20 Suppl 4:19-36. doi: 10.1111/1469-0691.12450.Clin Microbiol Infect. 2014.PMID: 24580739Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42699834) ## References 1. 1. Antonanzas F, Lozano C, Torres C. Economic features of antibiotic resistance: the case of methicillin-resistant Staphylococcus aureus. Pharmacoeconomics. 2015;33(4):285–325. doi: 10.1007/s40273-014-0242-y. - [DOI](https://doi.org/10.1007/s40273-014-0242-y) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/25447195/) 2. 1. Lodise TP, McKinnon PS. Clinical and economic impact of methicillin resistance in patients with Staphylococcus aureus bacteremia. Diagn Microbiol Infect Dis. 2005;52(2):113–22. doi: 10.1016/j.diagmicrobio.2005.02.007. - [DOI](https://doi.org/10.1016/j.diagmicrobio.2005.02.007) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/15964499/) 3. 1. Canadian Antimicrobial Resistance Surveillance System (CARSS): antimicrobial resistance. Public Health Agency of Canada, Health Infobase; 2024. Nov, [cited 2025 Sep 6]. Available from: . 4. 1. German GJ, Frenette C, Caissy JA, Grant J, Le
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