Skip to main content Accessibility help
×
Home

Healthcare-Associated Infection and Hospital Readmission

  • Carley B. Emerson (a1), Lindsay M. Eyzaguirre (a1), Jennifer S. Albrecht (a1), Angela C. Comer (a1), Anthony D. Harris (a1) and Jon P. Furuno (a1) (a2)...

Abstract

Objective.

Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.

Design.

Retrospective cohort study.

Patients and Setting.

Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008.

Methods.

The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results.

Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.

Conclusions.

Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.

Copyright

Corresponding author

OSU/OHSU College of Pharmacy, Department of Pharmacy Practice, 3303 SW Bond Avenue, Mail Code: CH12C, Portland, OR 97239 (furuno@ohsu.edu)

Footnotes

Hide All
a.

C.B.E. and L.M.E. contributed equally to this article

Footnotes

References

Hide All
1. Jencks, SF, Williams, MV, Coleman, EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:14181428.
2. Kang, C, Kim, S, Park, W, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 2005;49:760766.
3. Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:1935.
4. Toubes, E, Singh, K, Yin, D, et al. Risk factors for antibiotic-resistant infection and treatment outcomes among hospitalized patients transferred from long-term care facilities: does antimicrobial choice make a difference? Clin Infect Dis 2003;36: 724730.
5. Harris, A, Furuno, J, Roghmann, M, et al. Targeted surveillance of methicillin-resistant Staphylococcus aureus and its potential use to guide empiric antibiotic therapy. Antimicrob Agents Chemother 2010;54:31433148.
6. Furuno, JP, McGregor, JC, Harris, AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166:580585.
7. Furuno, JP, Harris, AD, Wright, MO, et al. Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28:666670.
8. Schweizer, ML, Furuno, JP, Harris, AD, et al. Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study. PLoS ONE 2010;5:e11432.
9. ICD-9-CM: International Classification of Diseases, 9th Revision; Clinical Modification, 6th Edition. Vol 1-3. 9th ed. Los Angeles, CA: Practice Management Information; 2006.
10. Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. JClin Epidemiol 1994;47: 12451251.
11. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166174.
12. Cowie, SE, Ma, I, Lee, SK, Smith, RM, Hsiang, YN. Nosocomial MRSA infection in vascular surgery patients: impact on patient outcome. Vase Endovascular Surg 2005;39:327334.
13. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, P. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidem 2007;28: 140145.
14. Anderson, PK, Gill, RD. Cox's regression model for counting processes: a large sample study. Ann Stat 1982;10:1100.
15. Anderson, D, Kaye, K, Chen, L, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE 2009;4:e8305.
16. Chu, LW, Pei, CK. Risk factors for early emergency hospital read-mission in elderly medical patients. Gerontol 1999;45:220226.
17. Williams, S, Bottle, A, Aylin, P. Length of hospital stay and subsequent emergency readmission. BMJ 2005;331:371.
18. Hasan, O, Meitzer, DO, Shaykevich, SA, et al. Hospital readmis sion in general medicine patients: a prediction model. J Gen Intern Med 2010;25:211219.
19. Marcantonio, ER, Goldfinger, M, Brennan, TA, McKean, S. Risk factors for unplanned readmission in members of a Medicare HMO. Am J Med 1997;45:P142.
20. Marcantonio, ER, McKean, S, Goldfinger, M, Kleefield, S, Yur-kofsky, M, Brennan, TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. J Am Geriatr Soc 1999;107: 1317.

Healthcare-Associated Infection and Hospital Readmission

  • Carley B. Emerson (a1), Lindsay M. Eyzaguirre (a1), Jennifer S. Albrecht (a1), Angela C. Comer (a1), Anthony D. Harris (a1) and Jon P. Furuno (a1) (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed