Kengo Inagaki1, Jose Lucar2, Chad Blackshear3, Charlotte V Hobbs1. 1. Department of Pediatrics, University of Mississippi Medical Center, Jackson. 2. Department of Medicine, University of Mississippi Medical Center, Jackson. 3. Data Science, University of Mississippi Medical Center, Jackson.
Abstract
BACKGROUND: Information on outcomes of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA, respectively) bacteremia, particularly readmission, is scarce and requires further research to inform optimal patient care. METHODS: We performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified MSSA and MRSA bacteremia using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged ≥18 years. Thirty-day readmission, mortality, length of stay, and costs were assessed using Cox proportional hazards regression, logistic regression, Poisson regression, and generalized linear model with gamma distribution and log link, respectively. RESULTS: Of 92 089 (standard error [SE], 1905) patients with S. aureus bacteremia, 48.5% (SE, 0.4%) had MRSA bacteremia. Thirty-day readmission rate was 22% (SE, 0.3) overall with no difference between MRSA and MSSA, but MRSA bacteremia had more readmission for bacteremia recurrence (hazard ratio, 1.17 [95% confidence interval {CI}, 1.02-1.34]), higher in-hospital mortality (odds ratio, 1.15 [95% CI, 1.07-1.23]), and longer hospitalization (incidence rate ratio, 1.09 [95% CI, 1.06-1.11]). Readmission with bacteremia recurrence was particularly more common among patients with endocarditis, immunocompromising comorbidities, and drug abuse. The cost of readmission was $12 425 (SE, $174) per case overall, and $19 186 (SE, $623) in those with bacteremia recurrence. CONCLUSIONS: Thirty-day readmission after S. aureus bacteremia is common and costly. MRSA bacteremia is associated with readmission for bacteremia recurrence, increased mortality, and longer hospitalization. Efforts should continue to optimize patient care, particularly for those with risk factors, to decrease readmission and associated morbidity and mortality in patients with S. aureus bacteremia.
BACKGROUND: Information on outcomes of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA, respectively) bacteremia, particularly readmission, is scarce and requires further research to inform optimal patient care. METHODS: We performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified MSSA and MRSAbacteremia using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged ≥18 years. Thirty-day readmission, mortality, length of stay, and costs were assessed using Cox proportional hazards regression, logistic regression, Poisson regression, and generalized linear model with gamma distribution and log link, respectively. RESULTS: Of 92 089 (standard error [SE], 1905) patients with S. aureus bacteremia, 48.5% (SE, 0.4%) had MRSAbacteremia. Thirty-day readmission rate was 22% (SE, 0.3) overall with no difference between MRSA and MSSA, but MRSAbacteremia had more readmission for bacteremia recurrence (hazard ratio, 1.17 [95% confidence interval {CI}, 1.02-1.34]), higher in-hospital mortality (odds ratio, 1.15 [95% CI, 1.07-1.23]), and longer hospitalization (incidence rate ratio, 1.09 [95% CI, 1.06-1.11]). Readmission with bacteremia recurrence was particularly more common among patients with endocarditis, immunocompromising comorbidities, and drug abuse. The cost of readmission was $12 425 (SE, $174) per case overall, and $19 186 (SE, $623) in those with bacteremia recurrence. CONCLUSIONS: Thirty-day readmission after S. aureus bacteremia is common and costly. MRSAbacteremia is associated with readmission for bacteremia recurrence, increased mortality, and longer hospitalization. Efforts should continue to optimize patient care, particularly for those with risk factors, to decrease readmission and associated morbidity and mortality in patients with S. aureus bacteremia.
Authors: Cecilia F Volk; Sarah Burgdorf; Graham Edwardson; Victor Nizet; George Sakoulas; Warren E Rose Journal: Clin Infect Dis Date: 2020-06-10 Impact factor: 9.079
Authors: Ashley N Rose; Paula Clogher; Kelly M Hatfield; Runa H Gokhale; Isaac See; Susan Petit Journal: Infect Control Hosp Epidemiol Date: 2020-06 Impact factor: 3.254
Authors: Kyle C Molina; Taylor Morrisette; Matthew A Miller; Vanthida Huang; Douglas N Fish Journal: Antimicrob Agents Chemother Date: 2020-06-23 Impact factor: 5.191
Authors: Ayesha Appa; Meredith Adamo; Stephenie Le; Jennifer Davis; Lisa Winston; Sarah B Doernberg; Henry Chambers; Marlene Martin; Nancy K Hills; Phillip O Coffin; Vivek Jain Journal: Clin Infect Dis Date: 2022-01-29 Impact factor: 9.079
Authors: Marin L Schweizer; Kelly Richardson; Mary S Vaughan Sarrazin; Michihiko Goto; Daniel J Livorsi; Rajeshwari Nair; Bruce Alexander; Brice F Beck; Michael P Jones; Mireia Puig-Asensio; Daniel Suh; Madeline Ohl; Eli N Perencevich Journal: Clin Infect Dis Date: 2021-01-29 Impact factor: 9.079