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Post-discharge mortality in patients hospitalized with MRSA infection and/or colonization

  • A. SHARMA (a1) (a2), C. ROGERS (a1), D. RIMLAND (a1) (a3), C. STAFFORD (a1), S. SATOLA (a1) (a3), E. CRISPELL (a1) (a3) and R. GAYNES (a1) (a3)...

Summary

Methicillin-resistant Staphylococcus aureus (MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years, P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31–2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22–3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.

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Copyright

Corresponding author

*Author for correspondence: Dr R. Gaynes, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA. (Email: robert.gaynes@va.gov)

References

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1.Jevons, MP, Rolinson, GN, Knox, R. Celbenin resistant staphylococci. British Medical Journal 1961; 1: 124126.
2.Stone, ND, et al. Importance of bacterial burden among methicillin-resistant Staphylococcus aureus carriers in a long-term care facility. Infection Control and Hospital Epidemiology 2008; 29: 143148.
3.Wang, F-D, et al. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia. American Journal of Infection Control 2008; 36: 118122.
4.Tacconelli, E, Pop-Vicas, AE, D'Agata, EMC. Increased mortality among elderly patients with methicillin-resistant Staphylococcus aureus bacteraemia. Journal of Hospital Infection 2006; 64: 251256.
5.Cosgrove, SE, et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: Mortality, length of stay, and hospital charges. Infection Control and Hospital Epidemiology 2005; 26: 166174.
6.Romero-Vivas, J, et al. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clinical Infectious Diseases 1995; 21: 14171423.
7.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clinical Infectious Diseases 2006; 42: S82S89.
8.Engemann, JJ, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clinical Infectious Diseases 2003; 36: 592598.
9.Jain, R, et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. New England Journal of Medicine 2011; 364: 14191430.
10.Honda, H, et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infection Control and Hospital Epidemiology 2010; 31: 584591.
11.Davis, KA, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clinical Infectious Diseases 2004; 39: 776782.
12.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clinical Infectious Diseases 2003; 36: 281285.
13.Roghmann, MC, et al. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. Journal of Hospital Infection 2001; 47: 98103.
14.Muder, RR, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Annals of Internal Medicine 1991; 114: 107112.
15.Marschall, J, Muhlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infection Control and Hospital Epidemiology 2006; 27: 12061212.
16.Robicsek, A, Beaumont, JL, Peterson, LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clinical Infectious Diseases 2009; 48: 910913.
17.Scanvic, A, et al. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clinical Infectious Diseases 2001; 32: 13931398.
18.Larsson, A-K, et al. Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scandinavian Journal of Infectious Diseases 2011; 43: 456462.
19.Vriens, MR, et al. Methicillin resistant Staphylococcus aureus carriage among patients after hospital discharge. Infection Control and Hospital Epidemiology 2005; 26: 629633.
20.Datta, R, Huang, SS. Risk of infection and death due to methicillin- resistant Staphylococcus aureus in long-term carriers. Clinical Infectious Diseases 2008; 47: 176181.
21.Klevens, RM, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association 2007; 298: 17631771.
22.Wyllie, DH, Crook, DW, Peto, TEA. Mortality after Staphylococcus aureus bacteraemia in two hospitals in oxfordshire, 1997–2003: Cohort study. British Medical Journal 2006; 333: 281.
23.Hanses, F, et al. Risk factors associated with long-term prognosis of patients with Staphylococcus aureus bacteremia. Infection 2010; 38: 465470.
24.Asgeirsson, H, et al. Staphylococcus aureus bacteraemia in Iceland, 1995–2008: changing incidence and mortality. Clinical Microbiology and Infection 2011; 17: 513518.
25.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control 2008; 36: 309332.
26.Stamper, PD, et al. Clinical validation of the molecular BD GeneOhm StaphSR assay for direct detection of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in positive blood cultures. Journal of Clinical Microbiology 2007; 45: 21912196.
27.Paule, SM, et al. Performance of the BD GeneOhm methicillin-resistant Staphylococcus aureus test before and during high-volume clinical use. Journal of Clinical Microbiology 2007; 45: 29932998.
28.Diederen, B, et al. Performance of chromagar mrsa medium for detection of methicillin-resistant Staphylococcus aureus. Journal of Clinical Microbiology 2005; 43: 19251927.
29.Flayhart, D, et al. Multicenter evaluation of BBL Chromagar MRSA medium for direct detection of methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. Journal of Clinical Microbiology 2005; 43: 55365540.
30.SAS 9.2 software. Cary, NC: SAS Institute Inc., 2008.
31.Kleinbaum, D, et al. Applied Regression Analysis and Other Multivariable Methods, 4th edn.Belmont, CA: Thomson Brooks/Cole, 2008.
32.Belsley, D. Conditioning Diagnostics: Collinearity and Weak Data in Regression. New York, NY: John Wiley & Sons, 1991.
33.Kleinbaum, D, Klein, M. Survival Analysis: A Self-learning Text, 2nd edn.New York, NY: Springer-Verlag, 2005.
34.Westat. National survey of veterans, active duty service members, demobilized national guard and reserve members, family members, and surviving spouses. Rockville, MD, 2010.
35.Arnold, N, et al. Virec technical report 2: VANDI mortality data merge project: Edward Hines Jr. VA Hospital, Hines, IL: VA Information Resource Center, 2006.
36.Stenehjem, E, et al. Cephid Xpert MRSA cycle threshold in discordant colonization results and as a quantitative measure of nasal colonization burden. Journal of Clinical Microbiology 2012; 50: 20792081.
37.Kempker, RR, et al. Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA bacteremia. Journal of Infection 2010; 61: 372381.
38.Lessa, FC, et al. Impact of USA300 methicillin-resistant Staphylococcus aureus on clinical outcomes of patients with pneumonia or central line-associated bloodstream infections. Clinical Infectious Diseases 2012; 55: 232241.

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