Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus
OBJECTIVE The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location. METHODS We conducted a r...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2017-07, Vol.38 (7), p.848-856 |
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| creator | Nelson, Richard E Slayton, Rachel B Stevens, Vanessa W Jones, Makoto M Khader, Karim Rubin, Michael A Jernigan, John A Samore, Matthew H |
| description | OBJECTIVE The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location. METHODS We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score-matched subsample. RESULTS Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85-2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22-1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39-3.21) and colonizations (RR, 1.32; 95% CI, 1.22-1.50) had an increased risk of death at 30 days. CONCLUSIONS We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations. Infect Control Hosp Epidemiol 2017;38:848-856. |
| doi_str_mv | 10.1017/ice.2017.83 |
| format | Article |
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METHODS We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score-matched subsample. RESULTS Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85-2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22-1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39-3.21) and colonizations (RR, 1.32; 95% CI, 1.22-1.50) had an increased risk of death at 30 days. CONCLUSIONS We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations. Infect Control Hosp Epidemiol 2017;38:848-856.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2017.83</identifier><identifier>PMID: 28566096</identifier><language>eng</language><publisher>United States: Cambridge University Press</publisher><subject>Acinetobacter Infections - mortality ; Aged ; Aged, 80 and over ; Antibiotics ; Bacteria ; Carrier State - epidemiology ; Carrier State - microbiology ; Case-Control Studies ; Cross Infection - microbiology ; Cross Infection - mortality ; Drug resistance ; Drug Resistance, Multiple, Bacterial ; Enterobacteriaceae Infections - mortality ; Estimates ; Female ; Gram-negative bacteria ; Gram-Negative Bacterial Infections - mortality ; Gram-positive bacteria ; Health care ; Health care policy ; Hospitalization ; Hospitals ; Humans ; Independent variables ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Mortality ; Mortality risk ; Multidrug resistant organisms ; Nosocomial infections ; Nursing ; Patients ; Propensity Score ; Pseudomonas Infections - mortality ; Public health ; Retrospective Studies ; Staphylococcal Infections - mortality ; Staphylococcus infections ; United States - epidemiology ; United States Department of Veterans Affairs - statistics & numerical data ; Urinary tract diseases ; Urinary tract infections ; Urogenital system ; Veterans</subject><ispartof>Infection control and hospital epidemiology, 2017-07, Vol.38 (7), p.848-856</ispartof><rights>2017 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-448b1de7c67144f6d5270215424e8e0b8925bedbfa4b182dfbb13d33fc987a5e3</citedby><cites>FETCH-LOGICAL-c383t-448b1de7c67144f6d5270215424e8e0b8925bedbfa4b182dfbb13d33fc987a5e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2844771464/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2844771464?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,21367,27901,27902,33721,33722,43781,74045</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28566096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nelson, Richard E</creatorcontrib><creatorcontrib>Slayton, Rachel B</creatorcontrib><creatorcontrib>Stevens, Vanessa W</creatorcontrib><creatorcontrib>Jones, Makoto M</creatorcontrib><creatorcontrib>Khader, Karim</creatorcontrib><creatorcontrib>Rubin, Michael A</creatorcontrib><creatorcontrib>Jernigan, John A</creatorcontrib><creatorcontrib>Samore, Matthew H</creatorcontrib><title>Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>OBJECTIVE The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location. METHODS We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score-matched subsample. RESULTS Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85-2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22-1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39-3.21) and colonizations (RR, 1.32; 95% CI, 1.22-1.50) had an increased risk of death at 30 days. CONCLUSIONS We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations. Infect Control Hosp Epidemiol 2017;38:848-856.</description><subject>Acinetobacter Infections - mortality</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antibiotics</subject><subject>Bacteria</subject><subject>Carrier State - epidemiology</subject><subject>Carrier State - microbiology</subject><subject>Case-Control Studies</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - mortality</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Enterobacteriaceae Infections - mortality</subject><subject>Estimates</subject><subject>Female</subject><subject>Gram-negative bacteria</subject><subject>Gram-Negative Bacterial Infections - mortality</subject><subject>Gram-positive bacteria</subject><subject>Health care</subject><subject>Health care policy</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Independent variables</subject><subject>Male</subject><subject>Methicillin-Resistant Staphylococcus aureus</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mortality risk</subject><subject>Multidrug resistant organisms</subject><subject>Nosocomial infections</subject><subject>Nursing</subject><subject>Patients</subject><subject>Propensity Score</subject><subject>Pseudomonas Infections - mortality</subject><subject>Public health</subject><subject>Retrospective Studies</subject><subject>Staphylococcal Infections - mortality</subject><subject>Staphylococcus infections</subject><subject>United States - epidemiology</subject><subject>United States Department of Veterans Affairs - statistics & numerical data</subject><subject>Urinary tract diseases</subject><subject>Urinary tract infections</subject><subject>Urogenital system</subject><subject>Veterans</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkUtrFEEUhQsxmEl05V4K3ARCj_Xq7qrlmGgSyCj4AHdNPW5nKtR0jfUQ5r_4Y-0hMYirexffORz4EHpNyZIS2r_zFpZsfpaSP0ML2raq6SQXz9GCSKUayfiPY3SS8z0hpFeKvkDHTLZdR1S3QL9XpSRvatEmAF7HVHTwZY_jiK9Bh7KxOkGzyjlarws4fDONYIuPU8aXFXCJeF1D8S7Vu-YLZJ-Lngq-SnrbfII7XfwvwO-1LZC8xnpyeA1l460PwU__BL4WvdvsQ7TR2prxqiao-SU6GnXI8OrxnqLvHz98u7hubj9f3VysbhvLJS-NENJQB73teirE2LmW9YTRVjABEoiRirUGnBm1MFQyNxpDueN8tEr2ugV-is4eencp_qyQy7D12UIIeoJY80AVEYpIQfiMvv0PvY81TfO6gUkh-nlBJ2bq_IGyKeacYBx2yW912g-UDAdpwyxtOEgb5KHzzWNnNVtwT-xfS_wPTkuVoQ</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Nelson, Richard E</creator><creator>Slayton, Rachel B</creator><creator>Stevens, Vanessa W</creator><creator>Jones, Makoto M</creator><creator>Khader, Karim</creator><creator>Rubin, Michael A</creator><creator>Jernigan, John A</creator><creator>Samore, Matthew H</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus</title><author>Nelson, Richard E ; Slayton, Rachel B ; Stevens, Vanessa W ; Jones, Makoto M ; Khader, Karim ; Rubin, Michael A ; Jernigan, John A ; Samore, Matthew H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-448b1de7c67144f6d5270215424e8e0b8925bedbfa4b182dfbb13d33fc987a5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acinetobacter Infections - mortality</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antibiotics</topic><topic>Bacteria</topic><topic>Carrier State - epidemiology</topic><topic>Carrier State - microbiology</topic><topic>Case-Control Studies</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - mortality</topic><topic>Drug resistance</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Enterobacteriaceae Infections - mortality</topic><topic>Estimates</topic><topic>Female</topic><topic>Gram-negative bacteria</topic><topic>Gram-Negative Bacterial Infections - mortality</topic><topic>Gram-positive bacteria</topic><topic>Health care</topic><topic>Health care policy</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Independent variables</topic><topic>Male</topic><topic>Methicillin-Resistant Staphylococcus aureus</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Mortality risk</topic><topic>Multidrug resistant organisms</topic><topic>Nosocomial infections</topic><topic>Nursing</topic><topic>Patients</topic><topic>Propensity Score</topic><topic>Pseudomonas Infections - mortality</topic><topic>Public health</topic><topic>Retrospective Studies</topic><topic>Staphylococcal Infections - mortality</topic><topic>Staphylococcus infections</topic><topic>United States - epidemiology</topic><topic>United States Department of Veterans Affairs - statistics & numerical data</topic><topic>Urinary tract diseases</topic><topic>Urinary tract infections</topic><topic>Urogenital system</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nelson, Richard E</creatorcontrib><creatorcontrib>Slayton, Rachel B</creatorcontrib><creatorcontrib>Stevens, Vanessa W</creatorcontrib><creatorcontrib>Jones, Makoto M</creatorcontrib><creatorcontrib>Khader, Karim</creatorcontrib><creatorcontrib>Rubin, Michael A</creatorcontrib><creatorcontrib>Jernigan, John A</creatorcontrib><creatorcontrib>Samore, Matthew H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Health Management</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nelson, Richard E</au><au>Slayton, Rachel B</au><au>Stevens, Vanessa W</au><au>Jones, Makoto M</au><au>Khader, Karim</au><au>Rubin, Michael A</au><au>Jernigan, John A</au><au>Samore, Matthew H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect Control Hosp Epidemiol</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>38</volume><issue>7</issue><spage>848</spage><epage>856</epage><pages>848-856</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>OBJECTIVE The purpose of this study was to quantify the effect of multidrug-resistant (MDR) gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) on mortality following infection, regardless of patient location. METHODS We conducted a retrospective cohort study of patients with an inpatient admission in the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. We constructed multivariate log-binomial regressions to assess the impact of a positive culture on mortality in the 30- and 90-day periods following the first positive culture, using a propensity-score-matched subsample. RESULTS Patients identified with positive cultures due to MDR Acinetobacter (n=218), MDR Pseudomonas aeruginosa (n=1,026), and MDR Enterobacteriaceae (n=3,498) were propensity-score matched to 14,591 patients without positive cultures due to these organisms. In addition, 3,471 patients with positive cultures due to MRSA were propensity-score matched to 12,499 patients without positive MRSA cultures. Multidrug-resistant gram-negative bacteria were associated with a significantly elevated risk of mortality both for invasive (RR, 2.32; 95% CI, 1.85-2.92) and noninvasive cultures (RR, 1.33; 95% CI, 1.22-1.44) during the 30-day period. Similarly, patients with MRSA HAIs (RR, 2.77; 95% CI, 2.39-3.21) and colonizations (RR, 1.32; 95% CI, 1.22-1.50) had an increased risk of death at 30 days. CONCLUSIONS We found that HAIs due to gram-negative bacteria and MRSA conferred significantly elevated 30- and 90-day risks of mortality. This finding held true both for invasive cultures, which are likely to be true infections, and noninvasive infections, which are possibly colonizations. Infect Control Hosp Epidemiol 2017;38:848-856.</abstract><cop>United States</cop><pub>Cambridge University Press</pub><pmid>28566096</pmid><doi>10.1017/ice.2017.83</doi><tpages>9</tpages></addata></record> |
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| subjects | Acinetobacter Infections - mortality Aged Aged, 80 and over Antibiotics Bacteria Carrier State - epidemiology Carrier State - microbiology Case-Control Studies Cross Infection - microbiology Cross Infection - mortality Drug resistance Drug Resistance, Multiple, Bacterial Enterobacteriaceae Infections - mortality Estimates Female Gram-negative bacteria Gram-Negative Bacterial Infections - mortality Gram-positive bacteria Health care Health care policy Hospitalization Hospitals Humans Independent variables Male Methicillin-Resistant Staphylococcus aureus Middle Aged Mortality Mortality risk Multidrug resistant organisms Nosocomial infections Nursing Patients Propensity Score Pseudomonas Infections - mortality Public health Retrospective Studies Staphylococcal Infections - mortality Staphylococcus infections United States - epidemiology United States Department of Veterans Affairs - statistics & numerical data Urinary tract diseases Urinary tract infections Urogenital system Veterans |
| title | Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus |
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