National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010-2014.

Background: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have been associated with worse patient outcomes and higher costs of care than methicillin-susceptible (MSSA) infections. However, since prior studies found these differences, the healthcare landscape has changed, including widespread dissemination of community-associated strains of MRSA. We sought to provide updated estimates of the excess costs of MRSA infections. Methods: We conducted a retrospective analysis using data from the National Inpatient Sample from the Agency for Healthcare Research and Quality for the years 2010-2014. We calculated costs for hospitalizations, including MRSA- and MSSA-related septicemia and pneumonia infections, as well as MRSA- and MSSA-related infections from conditions classified elsewhere and of an unspecified site ("other infections"). Differences in the costs of hospitalization were estimated using propensity score-adjusted mortality outcomes for 2010-2014. Results: In 2014, estimated costs were highest for pneumonia and sepsis-related hospitalizations. Propensity score-adjusted costs were significantly higher for MSSA-related pneumonia ($40725 vs $38561; P = .045) and other hospitalizations ($15578 vs $14792; P < .001) than for MRSA-related hospitalizations. Similar patterns were observed from 2010 to 2013, although crude cost differences between MSSA- and MRSA-related pneumonia hospitalizations rose from 25.8% in 2010 to 31.0% in 2014. Compared with MSSA-related hospitalizations, MRSA-related hospitalizations had a higher adjusted mortality rate. Conclusions: Although MRSA infections had been previously associated with higher hospitalization costs, our results suggest that, in recent years, costs associated with MSSA-related infections have converged with and may surpass costs of similar MRSA-related hospitalizations.

A framework for increasing the availability of life cycle inventory data based on the role of multinational companies.

PURPOSE: The aim of the paper is to assess the role and effectiveness of a proposed novel strategy for Life Cycle Inventory (LCI) data collection in the food sector and associated supply chains. The study represents one of the first of its type and provides answers to some of the key questions regarding the data collection process developed, managed and implemented by a multinational food company across the supply chain. METHODS: An integrated LCI data collection process for confectionery products was developed and implemented by Nestlé, a multinational food company. Some of the key features includes (1) management and implementation by a multinational food company; (2) types of roles to manage, provide and facilitate data exchange; (3) procedures to identify key products, suppliers and customers; (4) LCI questionnaire and cover letter and (5) data quality management based on the pedigree matrix. Overall, the combined features in an integrated framework provide a new way of thinking about the collection of LCI data from the perspective of a multinational food company. RESULTS AND DISCUSSION: The integrated LCI collection framework spanned across 5 months and resulted in 87 new LCI datasets for confectionery products from raw material, primary resource use, emission and waste release data collected from suppliers across 19 countries. The data collected was found to be of medium to high quality compared with secondary data. However, for retailers and waste service companies, only partially completed questionnaires were returned. Some of the key challenges encountered during the collection and creation of data included lack of experience, identifying key actors, communication and technical language, commercial compromise, confidentiality protection and complexity of multi-tiered supplier systems. A range of recommendations are proposed to reconcile these challenges which include standardisation of environmental data from suppliers, concise and targeted LCI questionnaires and visualising complexity through drawings. CONCLUSIONS: The integrated LCI data collection process and strategy has demonstrated the potential role of a multinational company to quickly engage and act as a strong enabler to unlock latent data for various aspects of the confectionery supply chain. Overall, it is recommended that the research findings serve as the foundations to transition towards a standardised procedure which can practically guide other multinational companies to considerably increase the availability of LCI data.