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Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

Published online by Cambridge University Press:  21 September 2015

Rupak Datta ,
Shawn Brown ,
Vinh Q. Nguyen ,
Chenghua Cao ,
John Billimek ,
Taliser Avery ,
Bruce Y. Lee  and
Susan S. Huang
Rupak Datta*
Affiliation:
Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Shawn Brown
Affiliation:
Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania
Vinh Q. Nguyen
Affiliation:
Department of Statistics, University of California Irvine, Irvine, California
Chenghua Cao
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
John Billimek
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Taliser Avery
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
Bruce Y. Lee
Affiliation:
Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
*
Address correspondence to Rupak Datta, MD, PhD, House Staff Office TMP 209, Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT 06510 (rupak.datta@yale.edu).
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Abstract

OBJECTIVE

To assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital.

METHODS

Retrospective multiple-cohort study of adults discharged from 1 hospital in 2005–2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers.

RESULTS

We evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N=121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P<.01).

CONCLUSIONS

Patients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed.

Infect. Control Hosp. Epidemiol. 2015;36(11):1275–1282

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1275 - 1282
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Presented in part: IDWeek 2012; San Diego, California; October 18, 2012 (Presentation 349, Session 52) and October 20, 2012 (Presentation 1550, Session 199); and the World Healthcare Associated Infection Forum; Veyrier-Du-Lac, France; June 23–25, 2013.

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