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Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008

  • Michael Z. David (a1), Sofia Medvedev (a2), Samuel F. Hohmann (a2), Bernard Ewigman (a1) and Robert S. Daum (a1)...
Abstract
Objective.

The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.

Design.

Retrospective cohort study.

Setting and Participants.

Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.

Methods.

Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.

Results.

The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.

Conclusions.

The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.

Copyright
Corresponding author
Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6054, Chicago, IL 60637 (mdavid@medicine.bsd.uchicago.edu)
References
Hide All
1.Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520532.
2.Jevons MP “Celbenin”-resistant Staphylococci. BMJ 1961;1:124125.
3.Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.
4.Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:29762984.
5.David MZ, Glikman D, Crawford SE, et al. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 2008;197:12351243.
6.Seybold U, Kourbatova EV, Johnson JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42:647656.
7.Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial strains? Clin Infect Dis 2008;46:787794.
8.Chua T, Moore CL, Perri MB, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates in Detroit. J Clin Microbiol 2008;46:23452352.
9.David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010;23:616687.
10.Maree CM, Daum RS, Boyle-Vavra S, Matayoshi K, Miller LG. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 2007;13:236242.
11.Wibbenmeyer LA, Kealey GP, Latenser BA, et al. Emergence of the USA300 strain of methicillin-resistant Staphylococcus aureus in a burn-trauma unit. J Burn Care Res 2008;29:790797.
12.Klevens MR, Morrison MA, Nadle J. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:17631771.
13.Kallen AJ, Mu Y, Bulens S, et al; Active Bacterial Core Surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. Health care-associated invasive MRSA infections, 2005–2008. JAMA 2010;304:641648.
14.Kuehnert MJ, Hill HA, Kupronis BA, Tokars JI, Solomon SL, Jernigan DB. Methicillin-resistant–Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11:868872.
15.Klein E, Smith DL, Laxminarayan R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis 2007;13:18401846.
16.McCaig LF, McDonald LC, Mandai S, Jernigan DB. Staphylococcus awrews-associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis 2006;12:17151723.
17.Zilberberg MD, Shorr AF, Kollef MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000–2005. Emerg Infect Dis 2008;14:17561758.
18.Jhung MA, Banerjee SN. Administrative coding data and health care-associated infections. Clin Infect Dis 2009;49:949955.
19.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;31:463468.
20.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;32:148154.
21.Zhan C, Elixhauser A, Richards CL, et al. Identification of hospital-acquired catheter-associated urinary tract infections from Medicare claims: sensitivity and positive predictive value. Med Care 2009;47:364369.
22.Jenkins TC, Sabel AL, Sarcone EE, Price CS, Mehler PS, Burman WJ. Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010;51:895903.
23. Changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates, 73 Federal Register 48434-49084 (August 19, 2008). Print.
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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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