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Inclusion of 30-Day Postdischarge Detection Triples the Incidence of Hospital-Onset Methicillin-Resistant Staphylococcus aureus

  • Taliser R. Avery (a1), Ken P. Kleinman (a1), Michael Klompas (a1), Ann Aschengrau (a2) and Susan S. Huang (a3)...

Abstract

Background.

Hospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge.

Objective.

We assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge.

Design.

Retrospective cohort study.

Setting.

Twenty-seven acute care hospitals in Orange County, California.

Participants.

Adult acute care admissions (2002–2007).

Methods.

Using a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients.

Results.

Among 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P<.0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA.

Conclusions.

On the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.

Infect Control Hosp Epidemiol 2012;33(2):114-121

Copyright

Corresponding author

Department of Population Medicine, Harvard Medical School and HPHC Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 (taliser_avery@hphc.org)

References

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1.Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis 2007;13(12):18401846.
2.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409418.
3.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al; Centers for Disease Control and Prevention Epicenters Program. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330338.
4.Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46(9):13681373.
5.Reynolds, C, Quan, V, Kim, D, et al. Methicillin-resistant Staphylococcus aureus (MRSA) carriage in 10 nursing homes in Orange County, California. Infect Control Hosp Epidemiol 2011;32(1):9193.
6.Klevens, RM, Morrison, MA, Nadle, J, et al; Active Bacterial Core Surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.
7. Community and Healthcare-Associated Infections Reduction Act of 2007, S.2278, 110th Cong, 1st Sess (2007).
8. MRSA Infection Prevention and Patient Protection Act, H.R.2937, 111th Cong, 1st Sess (2009).
9.Office of Statewide Health Planning and Development. California Inpatient Data Reporting Manual. 7th ed, version 7.6; September 2011. http://www.oshpd.ca.gov/HID/MIRCal/Text_pdfs/ManualsGuides/IPManual/TofC.pdf. Accessed December 16, 2011.
10.Glance, LG, Dick, AW, Osier, TM, Mukamel, DB. Accuracy of hospital report cards based on administrative data. Health Serv Res 2006;41(4 Pt 1):14131437.
11.Technical Advisory Committee meeting minutes, Office of Statewide Health Planning and Development, April 1, 2008. http://www.oshpd.ca.gov/Boards/CHPDAC/MeetingMinutes/TAC20080811.pdf. Accessed April 8, 2011.
12.Romano, PS, Roos, LL, Jollis, JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 1993;46(10):10751079.
13.Schneeweiss, S, Seeger, JD, Maclure, M, Wang, PS, Avorn, J, Glynn, RJ. Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 2001;154(9):854864.
14.Schneeweiss, S, Wang, PS, Avorn, J, Maclure, M, Levin, R, Glynn, RJ. Consistency of performance ranking of comorbidity adjustment scores in Canadian and U.S. utilization data. J Gen Intern Med 2004;19(5 Pt 1):444450.
15.Huang, SS, Placzek, H, Livingston, J, et al. Use of medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery. Infect Control Hosp Epidemiol 2011;32(8):775783.
16.Byrd, KK, Holman, RC, Bruce, MG, et al. Methicillin-resistant Staphylococcus aureus–associated hospitalizations among the American Indian and Alaska Native population. Clin Infect Dis 2009;49(7):10091015.
17.Gerber, JS, Coffin, SE, Smathers, SA, Zaoutis, TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clin Infect Dis 2009;49(1):6571.
18.Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant–Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11(6):868872. Erratum in: Emerg Infect Dis 2006;12(9):1472.
19.McCaig, LF, McDonald, LC, Mandal, S, Jernigan, DB. Staphylococcus aureus–associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis 2006;12(11):17151723.
20.Schaefer, MK, Ellingson, K, Conover, C, et al. Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification codes for reporting methicillin-resistant Staphylococcus aureus infections at a hospital in Illinois. Infect Control Hosp Epidemiol 2010;31(5):463468.
21.Schweizer, ML, Eber, MR, Laxminarayan, R, et al. Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease? Infect Control Hosp Epidemiol 2011;32(2):148154.
22. §3008. Payment adjustment for conditions acquired in hospitals. Patient Protection and Affordable Care Act, H.R.3590, 111th Cong, 2nd Sess (2009).
23.Breslow, NE, Clayton, DG. Approximate inference in generalized linear mixed models. J Am Stat Assoc 1993;88:925.
24.Behrman, RE, Benner, JS, Brown, JS, McClellan, M, Woodcock, J, Piatt, R. Developing the Sentinel System—a national resource for evidence development. N Engl J Med 2011;364(6):498499.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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