耐甲氧西林敏感和耐甲氧西林金黄色葡萄球菌菌血症：美国 30 天再入院率、住院死亡率、住院时间和费用的全国估计。

Methicillin-susceptible and Methicillin-resistant Staphylococcus aureus Bacteremia: Nationwide Estimates of 30-Day Readmission, In-hospital Mortality, Length of Stay, and Cost in the United States.

机构信息

Department of Pediatrics, University of Mississippi Medical Center, Jackson.

Department of Medicine, University of Mississippi Medical Center, Jackson.

出版信息

Clin Infect Dis. 2019 Nov 27;69(12):2112-2118. doi: 10.1093/cid/ciz123.

DOI:10.1093/cid/ciz123

PMID:30753447

Abstract

BACKGROUND

Information on outcomes of methicillin-susceptible and -resistant Staphylococcus aureus (MSSA and MRSA, respectively) bacteremia, particularly readmission, is scarce and requires further research to inform optimal patient care.

METHODS

We performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified MSSA and MRSA bacteremia using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged ≥18 years. Thirty-day readmission, mortality, length of stay, and costs were assessed using Cox proportional hazards regression, logistic regression, Poisson regression, and generalized linear model with gamma distribution and log link, respectively.

RESULTS

Of 92 089 (standard error [SE], 1905) patients with S. aureus bacteremia, 48.5% (SE, 0.4%) had MRSA bacteremia. Thirty-day readmission rate was 22% (SE, 0.3) overall with no difference between MRSA and MSSA, but MRSA bacteremia had more readmission for bacteremia recurrence (hazard ratio, 1.17 [95% confidence interval {CI}, 1.02-1.34]), higher in-hospital mortality (odds ratio, 1.15 [95% CI, 1.07-1.23]), and longer hospitalization (incidence rate ratio, 1.09 [95% CI, 1.06-1.11]). Readmission with bacteremia recurrence was particularly more common among patients with endocarditis, immunocompromising comorbidities, and drug abuse. The cost of readmission was $12 425 (SE, $174) per case overall, and $19 186 (SE, $623) in those with bacteremia recurrence.

CONCLUSIONS

Thirty-day readmission after S. aureus bacteremia is common and costly. MRSA bacteremia is associated with readmission for bacteremia recurrence, increased mortality, and longer hospitalization. Efforts should continue to optimize patient care, particularly for those with risk factors, to decrease readmission and associated morbidity and mortality in patients with S. aureus bacteremia.

摘要

背景

耐甲氧西林金黄色葡萄球菌（MSSA 和 MRSA，分别）菌血症的结局，特别是再入院情况的相关信息非常有限，需要进一步研究以提供最佳的患者护理。

方法

我们使用 2014 年全国再入院数据库进行回顾性分析，该数据库涵盖了美国 49.3%的住院患者。我们在年龄≥18 岁的患者中使用国际疾病分类，第九版临床修正版来识别 MSSA 和 MRSA 菌血症。使用 Cox 比例风险回归、逻辑回归、泊松回归和广义线性模型（具有伽马分布和对数链接）分别评估 30 天再入院率、死亡率、住院时间和费用。

结果

在 92089 例（标准误差[SE]，1905）金黄色葡萄球菌菌血症患者中，48.5%（SE，0.4%）为 MRSA 菌血症。总体 30 天再入院率为 22%（SE，0.3），MRSA 和 MSSA 之间无差异，但 MRSA 菌血症的菌血症复发再入院率更高（风险比，1.17[95%置信区间{CI}，1.02-1.34]），住院期间死亡率更高（优势比，1.15[95%CI，1.07-1.23]），住院时间更长（发病率比，1.09[95%CI，1.06-1.11]）。菌血症复发是导致再入院的主要原因，特别是在患有心内膜炎、免疫功能低下合并症和药物滥用的患者中更为常见。总体而言，再入院的费用为每例 12425 美元（SE，174 美元），菌血症复发患者的费用为 19186 美元（SE，623 美元）。