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Attributable Mortality of Healthcare-Associated Infections Due to Multidrug-Resistant Gram-Negative Bacteria and Methicillin-Resistant Staphylococcus Aureus

Published online by Cambridge University Press:  01 June 2017

Richard E. Nelson ,
Rachel B. Slayton ,
Vanessa W. Stevens ,
Makoto M. Jones ,
Karim Khader ,
Michael A. Rubin ,
John A. Jernigan  and
Matthew H. Samore
Richard E. Nelson*
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Rachel B. Slayton
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Vanessa W. Stevens
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Makoto M. Jones
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Karim Khader
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Michael A. Rubin
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Matthew H. Samore
Affiliation:
Veterans Affairs Salt Lake City Health System IDEAS Center, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
*
Address correspondence to Richard E. Nelson, PhD, 500 Foothill Blvd, Salt Lake City, UT 84148 (richard.nelson@utah.edu).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 848 - 856
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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