Skip to main content Accessibility help

The Economic Impact of Methicillin-Resistant Staphylococcus aureus in Canadian Hospitals

  • Tony Kim (a1), Paul I. Oh (a1) (a2) (a3) and Andrew E. Simor (a2) (a4) (a3)



To determine the costs associated with the management of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals.


Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions.


A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada.


Inpatients with at least one culture yielding MRSA between April 1996 and March 1998.


A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient. The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually.


These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.


Corresponding author

Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Ave, North York, Ontario M4N 3M5, Canada


Hide All
1. Panlilio, AL, Culver, DH, Gaynes, RP, Banerjee, S, Henderson, TS, Tolson, JS, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582586.
2. Riley, TV, Pearman, JW, Rouse, IL. Changing epidemiology of methicillin-resistant Staphylococcus aureus in western Australia. Med J Aust 1995;163:412414.
3. Witte, W, Kresken, M, Braulke, C, Cuny, C. Increasing incidence and wide-spread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals. Clin Microbiol Infect 1997;3:414422.
4. The Hôpital Propre II Study Group. Methicillin-resistant Staphylococcus aureus in French hospitals: a 2-month survey in 43 hospitals, 1995. Infect Control Hosp Epidemiol 1999;20:478486.
5. Austin, DJ, Anderson, RM. Transmission dynamics of epidemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in England and Wales. J Infect Dis 1999;179:883891.
6. Low, DE, Garcia, M, Callery, S, Milne, P, Devlin, HR, Campbell, I, et al. Methicillin-resistant Staphylococcus aureus—Ontario. Canada Dis Weekly Rep 1981;7:249250.
7. Embil, J, Ramotar, K, Romance, L, Alfa, M, Conly, J, Cronk, S, et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies 1990-1992. Infect Control Hosp Epidemiol 1994;15:646651.
8. Roman, RS, Smith, J, Walker, M, Byrne, S, Ramotar, K, Dyck, B, et al. Rapid geographic spread of a methicillin-resistant Staphylococcus aureus strain. Clin Infect Dis 1997;25:698705.
9. Suh, K, Toye, B, Jessamine, P, Chan, F, Ramotar, K. Epidemiology of methicillin-resistant Staphylococcus aureus in three Canadian tertiary-care centers. Infect Control Hosp Epidemiol 1998;19:395400.
10. Simor, A, Ofner-Agostini, M, Paton, S. The Canadian Nosocomial Infection Surveillance Program: results of the first 18 months of surveillance for methicillin-resistant Staphylococcus aureus in Canadian hospitals. Can Commun Dis Rep 1997;23:4145.
11. Simor, AE, Ofner-Agostini, M, Bryce, E, Green, K, McGeer, A, Mulvey, M, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Canada: five years of national surveillance. Presented at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 17-20, 2000; Toronto, Ontario, Canada. Abstract 159.
12. Simor, AE, Boyd, D, Louie, L, McGeer, A, Mulvey, M, Willey, BM. Characterization and proposed nomenclature of epidemic strains of MRSA in Canada. Can J Infect Dis 1999;10:333336.
13. McGeer, A, Saginur, M, Green, K, Fleming, CA, Low, DE. MRSA and VRE in Ontario—still room for optimism! Laboratory Proficiency Testing Program Newslttr 1999;258:14.
14. Bradley, SF. Methicillin-resistant Staphylococcus aureus in nursing homes: epidemiology, prevention and management. Drug Aging 1997;10:185198.
15. Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797800.
16. Casewell, MW, Hill, RLR. The carrier state: methicillin-resistant Staphylococcus aureus . J Antimicrob Chemother 1986;18(suppl A):112.
17. Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995;21:14171423.
18. Ibelings, MMS, Bruining, HA. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998;164:411418.
19. Hiramatsu, K, Aritaka, N, Hanaki, H, Kawasaki, S, Hosoda, Y, Hori, S, et al. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350:16701673.
20. Smith, TL, Pearson, ML, Wilcox, KR, Cruz, C, Lancaster, MV, Robinson-Dunn, B, et al. Emergence of vancomycin resistance in Staphylococcus aureus . N Engl J Med 1999;340:493501.
21. Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 1988;9:255260.
22. Wakefield, DS, Helms, CM, Massanari, RM, Mori, M, Pfaller, M. Cost of nosocomial infection: relative contributions of laboratory, antibiotic, and per diem costs in serious Staphylococcus aureus infections. Am J Infect Control 1988;16:185192.
23. Rubin, RJ, Harrington, CA, Poon, A, Dietrich, K, Greene, JA, Moiduddin, A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:917.
24. Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost-effective? Infect Control Hosp Epidemiol 1999;20:473477.
25. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.
26. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 5th ed. Wayne, PA: NCCLS; 2000. Approved Standard M7-A5.
27. Gertman, PM, Restuccia, JD. The Appropriateness Evaluation Protocol: a technique for assessing unnecessary days of hospital care. Med Care 1981;19:855871.
28. Wakefield, DS, Pfaller, MA, Hammons, GT, Massanari, RM. Use of the Appropriateness Evaluation Protocol for estimating the incremental costs associated with nosocomial infections. Med Care 1987;25:481488.
29. Zoutman, D, McDonald, S, Vethanayagan, D. Total and attributable costs of surgical wound infections at a Canadian tertiary-care center. Infect Control Hosp Epidemiol 1998;19:254259.
30. Boyce, JM, Jackson, MM, Pugliese, G, Batt, MD, Fleming, D, Garner, JS, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105115.
31. Jernigan, JA Clemence, MA, Stott, GA, Titus, MG, Alexander, CH, Palumbo, CM, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686696.
32. Statistics Canada. The Daily Catalogue 11-O01E. Ottawa, Ontario, Canada: Statistics Canada; February 24, 1999.
33. Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Clin Infect Dis 1987;9:10651078.
34. Carmeli, Y, Troillet, N, Karchmer, AW, Samore, MH. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa . Arch Intern Med 1999;159:11271132.
35. Bryce, EA, Tiffin, SM, Isaac-Renton, JL, Wright, CJ. Evidence of delays in transferring patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus to long-term–care facilities. Infect Control Hosp Epidemiol 2000;21:270271.
36. Bryce, EA, Kerschbaumer, V. The cost of doing business—managing MRSA and VRE. 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Infect Control Hosp Epidemiol 2000;21:119. Abstract SM5-05.
37. Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methiclllin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408411.
38. Welch, KE, Goff, DA, Fish, DN, Sierawski, SJ, Paladino, JA. A multicenter economic analysis of bacteremia caused by methicillin-resistant Staphylococcus aureus. 39th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 26-29, 1999; San Francisco, CA. Abstract 1865.
39. Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, JE Jr Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248257.
40. Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91(suppl 3B):32S38S.
41. Chrischilles, EA, Scholz, DA. Dollars and sense: a practical guide to cost analysis for hospital epidemiology and infection control. Clinical Performance and Quality Health Care 1999;7:107111.
42. Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:4654.
43. Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus. A cost-benefit analysis in an intensive care unit. JAMA 1999;282:17451751.
44. Jernigan, JA Titus, MG, Gröschel, DHM, Getchell-White, SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus . Am J Epidemiol 1996;143:496504.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed