BACKGROUND: Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge. OBJECTIVE: We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge. DESIGN: Retrospective cohort study. SETTING: Twenty-seven acute care hospitals in Orange County, California. PARTICIPANTS: Adult acute care admissions (2002-2007). METHODS: Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients. RESULTS: Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P < .0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA. CONCLUSIONS: On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.
BACKGROUND: Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge. OBJECTIVE: We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge. DESIGN: Retrospective cohort study. SETTING: Twenty-seven acute care hospitals in Orange County, California. PARTICIPANTS: Adult acute care admissions (2002-2007). METHODS: Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients. RESULTS: Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P < .0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA. CONCLUSIONS: On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.
Authors: Deverick J Anderson; Luke F Chen; David J Weber; Rebekah W Moehring; Sarah S Lewis; Patricia F Triplett; Michael Blocker; Paul Becherer; J Conrad Schwab; Lauren P Knelson; Yuliya Lokhnygina; William A Rutala; Hajime Kanamori; Maria F Gergen; Daniel J Sexton Journal: Lancet Date: 2017-01-17 Impact factor: 79.321
Authors: Bruce Y Lee; Sarah M Bartsch; Kim F Wong; Ashima Singh; Taliser R Avery; Diane S Kim; Shawn T Brown; Courtney R Murphy; Server Levent Yilmaz; Margaret A Potter; Susan S Huang Journal: Med Care Date: 2013-03 Impact factor: 2.983
Authors: Patrick N A Harris; Bich Diep Le; Paul Tambyah; Li Yang Hsu; Surinder Pada; Sophia Archuleta; Sharon Salmon; Amartya Mukhopadhyay; Jasmine Dillon; Robert Ware; Dale A Fisher Journal: Open Forum Infect Dis Date: 2015-05-22 Impact factor: 3.835
Authors: Kalpana Gupta; Richard A Martinello; Melissa Young; Judith Strymish; Kelly Cho; Elizabeth Lawler Journal: PLoS One Date: 2013-01-10 Impact factor: 3.240