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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...

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Autores principales: Rentinck, Marc-Nicolas, Krüger, Renate, Hoppe, Pia-Alice, Humme, Daniel, Niebank, Michaela, Pokrywka, Anna, Stegemann, Miriam, Kola, Axel, Hanitsch, Leif Gunnar, Leistner, Rasmus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
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.
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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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