Giuseppe
Emeritus
[Source: Antimicrobial Agents and Chemotherapy, full text: (LINK). Abstract, edited.]
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Long-Term Risk for Readmission, Methicillin-resistant Staphylococcus aureus (MRSA) Infection, and Death among MRSA-Colonized Veterans
Nestor M. Quezada Joaquin 1, Daniel J. Diekema 1, Eli N. Perencevich 1,2,3, George Bailey 3, Patricia L. Winokur 1,3 and Marin L. Schweizer 1,2,3,#
Author Affiliations: <SUP>1</SUP>Division of Infectious Diseases <SUP>2</SUP>Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine <SUP>3</SUP>Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
ABSTRACT
Background:
While numerous studies assessed outcomes of MRSA colonization over the short term, little is known about longer-term outcomes after discharge. An assessment of long-term outcomes could inform the utility of various MRSA prevention approaches.
Methods:
A matched cohort study was performed among Veterans Affairs (VA) patients screened for MRSA colonization between the years 2007 and 2009 and followed to evaluate outcomes until 2010. Cox proportional hazard models were used to evaluate the association between MRSA colonization and long-term outcomes such as infection-related readmission, and crude mortality.
Results:
404 veterans were included, 206 of whom were MRSA carriers and 198 who were non-carriers. There were no culture-proven MRSA infections on readmission among the non-carriers, but 13% of MRSA-carriers were readmitted with culture proven MRSA infections on readmission (P<0.01). MRSA carriers were significantly more likely to be readmitted, be readmitted more than once due to proven or probable MRSA infections, and be readmitted within 90 days of discharge compared to non-carriers (p<0.05). Infection-related readmission (adjusted hazard ratio [AHR] =4.07; 95% confidence interval [CI]: 2.16, 7.67) and mortality (AHR=2.71; 95% CI: 1.87, 3.91) were significantly higher among MRSA carriers compared to non-carriers, after statistically adjusting for potential confounders.
Conclusions:
Among a cohort of VA patients, MRSA carriers are at high risk of infection-related readmission, MRSA infection and mortality compared to non-carriers. Non- carriers are at very low risk of subsequent MRSA infection. Future studies should address whether interventions such as nasal or skin decolonization could result in improved outcomes for MRSA carriers.
FOOTNOTES
#Corresponding author: Marin L. Schweizer, PhD, Iowa City VA Health Care System (152), 601 Highway 6 West, Iowa City, IA 52246, marin-schweizer@uiowa.edu, t: 319-338-0581, f: (319) 887-4932
Copyright ? 2012, American Society for Microbiology. All Rights Reserved.
-Nestor M. Quezada Joaquin 1, Daniel J. Diekema 1, Eli N. Perencevich 1,2,3, George Bailey 3, Patricia L. Winokur 1,3 and Marin L. Schweizer 1,2,3,#
Author Affiliations: <SUP>1</SUP>Division of Infectious Diseases <SUP>2</SUP>Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine <SUP>3</SUP>Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
ABSTRACT
Background:
While numerous studies assessed outcomes of MRSA colonization over the short term, little is known about longer-term outcomes after discharge. An assessment of long-term outcomes could inform the utility of various MRSA prevention approaches.
Methods:
A matched cohort study was performed among Veterans Affairs (VA) patients screened for MRSA colonization between the years 2007 and 2009 and followed to evaluate outcomes until 2010. Cox proportional hazard models were used to evaluate the association between MRSA colonization and long-term outcomes such as infection-related readmission, and crude mortality.
Results:
404 veterans were included, 206 of whom were MRSA carriers and 198 who were non-carriers. There were no culture-proven MRSA infections on readmission among the non-carriers, but 13% of MRSA-carriers were readmitted with culture proven MRSA infections on readmission (P<0.01). MRSA carriers were significantly more likely to be readmitted, be readmitted more than once due to proven or probable MRSA infections, and be readmitted within 90 days of discharge compared to non-carriers (p<0.05). Infection-related readmission (adjusted hazard ratio [AHR] =4.07; 95% confidence interval [CI]: 2.16, 7.67) and mortality (AHR=2.71; 95% CI: 1.87, 3.91) were significantly higher among MRSA carriers compared to non-carriers, after statistically adjusting for potential confounders.
Conclusions:
Among a cohort of VA patients, MRSA carriers are at high risk of infection-related readmission, MRSA infection and mortality compared to non-carriers. Non- carriers are at very low risk of subsequent MRSA infection. Future studies should address whether interventions such as nasal or skin decolonization could result in improved outcomes for MRSA carriers.
FOOTNOTES
#Corresponding author: Marin L. Schweizer, PhD, Iowa City VA Health Care System (152), 601 Highway 6 West, Iowa City, IA 52246, marin-schweizer@uiowa.edu, t: 319-338-0581, f: (319) 887-4932
Copyright ? 2012, American Society for Microbiology. All Rights Reserved.
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