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Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment
INTRODUCTION: Skin and soft tissue infections (SSTI) caused by Panton-Valentine leukocidin (PVL)-producing strains of Staphylococcus aureus (PVL-SA) are associated with recurrent skin abscesses. Secondary prevention, in conjunction with primary treatment of the infection, focuses on topical decoloni...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232536/ https://www.ncbi.nlm.nih.gov/pubmed/34170945 http://dx.doi.org/10.1371/journal.pone.0253633 |
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author | Rentinck, Marc-Nicolas Krüger, Renate Hoppe, Pia-Alice Humme, Daniel Niebank, Michaela Pokrywka, Anna Stegemann, Miriam Kola, Axel Hanitsch, Leif Gunnar Leistner, Rasmus |
author_facet | Rentinck, Marc-Nicolas Krüger, Renate Hoppe, Pia-Alice Humme, Daniel Niebank, Michaela Pokrywka, Anna Stegemann, Miriam Kola, Axel Hanitsch, Leif Gunnar Leistner, Rasmus |
author_sort | Rentinck, Marc-Nicolas |
collection | PubMed |
description | INTRODUCTION: Skin and soft tissue infections (SSTI) caused by Panton-Valentine leukocidin (PVL)-producing strains of Staphylococcus aureus (PVL-SA) are associated with recurrent skin abscesses. Secondary prevention, in conjunction with primary treatment of the infection, focuses on topical decolonization. Topical decolonization is a standard procedure in cases of recurrent PVL-SA skin infections and is recommended in international guidelines. However, this outpatient treatment is often not fully reimbursed by health insurance providers, which may interfere with successful PVL-SA decolonization. AIM: Our goal was to estimate the cost effectiveness of outpatient decolonization of patients with recurrent PVL-SA skin infections. We calculated the average cost of treatment for PVL-SA per outpatient decolonization procedure as well as per in-hospital stay. METHODS: The study was conducted between 2014 and 2018 at a German tertiary care university hospital. The cohort analyzed was obtained from the hospital’s microbiology laboratory database. Data on medical costs, DRG-based diagnoses, and ICD-10 patient data was obtained from the hospital’s financial controlling department. We calculated the average cost of treatment for patients admitted for treatment of PVL-SA induced skin infections. The cost of outpatient treatment is based on the German regulations of drug prices for prescription drugs. RESULTS: We analyzed a total of n = 466 swabs from n = 411 patients with recurrent skin infections suspected of carrying PVL-SA. PVL-SA was detected in 61.3% of all patients included in the study. Of those isolates, 80.6% were methicillin-susceptible, 19.4% methicillin-resistant. 89.8% of all patients were treated as outpatients. In 73.0% of inpatients colonized with PVL-SA the main diagnosis was SSTI. The median length of stay was 5.5 days for inpatients colonized with PVL-SA whose main diagnosis SSTI; the average cost was €2,283. The estimated costs per decolonization procedure in outpatients ranged from €50-€110, depending on the products used. CONCLUSION: Our data shows that outpatient decolonization offers a highly cost-effective secondary prevention strategy, which may prevent costly inpatient treatments. Therefore, health insurance companies should consider providing coverage of outpatient treatment of recurrent PVL-SA skin and soft tissue infections. |
format | Online Article Text |
id | pubmed-8232536 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-82325362021-07-07 Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment Rentinck, Marc-Nicolas Krüger, Renate Hoppe, Pia-Alice Humme, Daniel Niebank, Michaela Pokrywka, Anna Stegemann, Miriam Kola, Axel Hanitsch, Leif Gunnar Leistner, Rasmus PLoS One Research Article INTRODUCTION: Skin and soft tissue infections (SSTI) caused by Panton-Valentine leukocidin (PVL)-producing strains of Staphylococcus aureus (PVL-SA) are associated with recurrent skin abscesses. Secondary prevention, in conjunction with primary treatment of the infection, focuses on topical decolonization. Topical decolonization is a standard procedure in cases of recurrent PVL-SA skin infections and is recommended in international guidelines. However, this outpatient treatment is often not fully reimbursed by health insurance providers, which may interfere with successful PVL-SA decolonization. AIM: Our goal was to estimate the cost effectiveness of outpatient decolonization of patients with recurrent PVL-SA skin infections. We calculated the average cost of treatment for PVL-SA per outpatient decolonization procedure as well as per in-hospital stay. METHODS: The study was conducted between 2014 and 2018 at a German tertiary care university hospital. The cohort analyzed was obtained from the hospital’s microbiology laboratory database. Data on medical costs, DRG-based diagnoses, and ICD-10 patient data was obtained from the hospital’s financial controlling department. We calculated the average cost of treatment for patients admitted for treatment of PVL-SA induced skin infections. The cost of outpatient treatment is based on the German regulations of drug prices for prescription drugs. RESULTS: We analyzed a total of n = 466 swabs from n = 411 patients with recurrent skin infections suspected of carrying PVL-SA. PVL-SA was detected in 61.3% of all patients included in the study. Of those isolates, 80.6% were methicillin-susceptible, 19.4% methicillin-resistant. 89.8% of all patients were treated as outpatients. In 73.0% of inpatients colonized with PVL-SA the main diagnosis was SSTI. The median length of stay was 5.5 days for inpatients colonized with PVL-SA whose main diagnosis SSTI; the average cost was €2,283. The estimated costs per decolonization procedure in outpatients ranged from €50-€110, depending on the products used. CONCLUSION: Our data shows that outpatient decolonization offers a highly cost-effective secondary prevention strategy, which may prevent costly inpatient treatments. Therefore, health insurance companies should consider providing coverage of outpatient treatment of recurrent PVL-SA skin and soft tissue infections. Public Library of Science 2021-06-25 /pmc/articles/PMC8232536/ /pubmed/34170945 http://dx.doi.org/10.1371/journal.pone.0253633 Text en © 2021 Rentinck et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Rentinck, Marc-Nicolas Krüger, Renate Hoppe, Pia-Alice Humme, Daniel Niebank, Michaela Pokrywka, Anna Stegemann, Miriam Kola, Axel Hanitsch, Leif Gunnar Leistner, Rasmus Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title | Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title_full | Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title_fullStr | Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title_full_unstemmed | Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title_short | Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment |
title_sort | skin infections due to panton-valentine leukocidin (pvl)-producing s. aureus—cost effectiveness of outpatient treatment |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232536/ https://www.ncbi.nlm.nih.gov/pubmed/34170945 http://dx.doi.org/10.1371/journal.pone.0253633 |
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