Abstract
Background: MRSA has caused enormous burden to affected Western patients and society. However, only limited study results originated from the Asia-Pacific populations.
 Aim: To assess the burden of Methicillin-resistant S. aureus infections (MRSA) among patients from a large tertiary care hospital in Singapore.
 Methods: Retrospective study using data from the hospital discharge database to identify patients with MRSA and Methicillin-sensitive S. aureus infections (MSSA) using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes. 
 Findings: Amongst 543,068 hospitalized patients between 2004 and 2010, 8,664(1.6%) were infected with S. Aureus, including 4,868(0.9%) with MRSA. Compared with uninfected controls, MRSA patients had longer hospital stay (geometric mean, GM, 12.2 vs. 3.0 days), higher hospitalization costs (GM, $6294.7 vs. $2295.7), higher in-hospital mortality rate (7.8% vs. 2.8%) and higher 30-day all-cause unscheduled readmission rate (36.3% vs. 23.7%, all p<0.001). The difference still existed after adjustment for age groups, gender, ethnicity, medical management, and Charlson comorbidity index. Similarly, MRSA patients had longer hospital stay, higher hospitalization costs, higher in-hospital mortality rate and 30-day all-cause unscheduled readmission rate compared with patients with MSSA.
 Conclusion: MRSA infection was associated with poor clinical outcomes and higher economic burden in this population. Prevention and control measures should be implemented both inside and outside the hospital setting.
Highlights
Methicillin-resistant S. aureus infections (MRSA) patients had longer hospital stay, higher hospitalization costs (GM, $6294.7 vs. $2295.7), higher in-hospital mortality rate (7.8% vs. 2.8%) and higher 30-day all-cause unscheduled readmission rate (36.3% vs. 23.7%, all p
MRSA infection was associated with poor clinical outcomes and higher economic burden in this population
MRSA patients were older compared to Methicillin-sensitive S. aureus infections (MSSA) patients and uninfected controls (p
Summary
Since it was first reported as a nosocomial pathogen in US hospitals, Methicillin resistant Staphylococcus aureus (MRSA)infection has rapidly increased to epidemic proportions worldwide. The estimated number of S.aureus–related hospitalizations in US increased by 62% (or about 8.4% per year) from 294,570 in 1999 to 477,927 in 2005, and the estimated number of MRSA-related hospitalizations more than doubled from 127,036 to 278,203 over the same period (a rise of 14% per year). Infections by MRSA are estimated to cause 19,000 deaths among hospitalized patients in the US annually, similar to deaths due to AIDS, tuberculosis, and viral hepatitis combined. In the EuropeanUnion (EU), MRSA infections are estimated to affect more than 150,000 patients annually, resulting in additional in-hospital costs of EUR380 million for EU healthcare systems. MRSA has been found to be independently associated with hospitalization costs and increased length of stay in patients with S. aureus infections (including bacteraemia, surgical site infections, and ventilator-associated pneumonia).6-8Most studies to date have suffered from one or more limitations: Selected ones have only encompassed one type of S. aureus infection, whereas others have quantified costs for only short periods with limited sample sizes. Infections by MRSA are estimated to cause 19,000 deaths among hospitalized patients in the US annually, similar to deaths due to AIDS, tuberculosis, and viral hepatitis combined. . Union (EU), MRSA infections are estimated to affect more than 150,000 patients annually, resulting in additional in-hospital costs of EUR380 million for EU healthcare systems.. MRSA has been found to be independently associated with hospitalization costs and increased length of stay in patients with S. aureus infections (including bacteraemia, surgical site infections, and ventilator-associated pneumonia).. Most studies to date have suffered from one or more limitations: Selected ones have only encompassed one type of S. aureus infection, whereas others have quantified costs for only short periods with limited sample sizes. Almost all studies have originated in the USA and European countries, with very few from the AsiaPacific region. Only limited study results originated from the Asia-Pacific populations
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