852 infection control & hospital epidemiology july 2017, vol. 38, no. 7


table 2. Characteristics of Patients With Positive Cultures for Methicillin-Resistant Staphylococcus Aureus and Propensity Score-Matched Controls


No Positive MRSA Culture


Total


Culture type HAI


Colonization


Age, y BMI


<18.5


18.5–24.9 25–29.9 30–34.9 35+


Missing


Insurance No insurance Insurance Missing


Gender


Female Male


Missing


Race/Ethnicity White Black Asian


Native American Hispanic


Unknown/Missing


Marital Status Married


Never married Divorced Separated Widowed


Unknown/Missing CCI/Elixhauser


Outpatient cost in 365 d prior to admission


405


12,083 11


8,338 2,688 51 66


774 582


4,508 1,513 3,570 622


1,769 517 1.5


3.2


96.7 0.1


66.7 21.5 0.4 0.5 6.2 4.7


36.1 12.1 28.6 5.0


14.2 4.1 1.9


116


3,353 2


2,356 700 7


24


218 166


1,209 445


1,018 165 463 171 1.5


3.3


96.6 0.1


67.9 20.2 0.2 0.7 6.3 4.8


34.8 12.8 29.3 4.8


13.3 4.9 1.9


$10,427 $14,310 $10,879 $13,566


NOTE. MRSA, methicillin-resistant Staphylococcus aureus; SD, standard deviation; BMI, body mass index; CCI, Charlson comorbidity index.


evaluations of both the costs of the resources required to undertake the interventions and the benefits of prevented mortality and morbidity. Themeasures of attributable mortality that we found improve


upon estimates reported elsewhere in the published literature. For example, we recently published a study that used a simula- tion model parameterized using published data to estim- ate the mortality and cost burden of healthcare-associated MDR Acinetobacter infections. Using estimates from several published studies, we estimated an attributable mortality risk


Positive MRSA Culture


No./Mean %/SD No./Mean %/SD 12,499


… …


67.0 28.2 369


3,643 4,151 2,381 1,603 352


3,119 6,653 2,727


13.9 7.2 3.0


29.1 33.2 19.0 12.8 2.8


25.0 53.2 21.8


3,471 484


2,987 67.3 28.0 134


1,086 1,054 644 417 136


978


1,638 855


13.9 86.1 13.3 7.0 3.9


31.3 30.4 18.6 12.0 3.9


28.2 47.2 24.6


table 3. Incidence of Positive Clinical Cultures by Organism Incidencea


95% CI Organism


MDR Acinetobacter Total


Invasiveb Noninvasivec


MDR Pseudomonas Total


Invasive Noninvasive


MDR Enterobacteriaceae Total


Invasive Noninvasive


MRSA Total HAId


Colonizatione Mean


0.148 0.050 0.097


0.514 0.050 0.463


1.624 0.190 1.419


1.516 0.206 1.310


Lower


0.136 0.043 0.087


0.491 0.043 0.440


1.581 0.176 1.379


1.480 0.193 1.277


Upper


0.161 0.058 0.108


0.539 0.058 0.486


1.668 0.204 1.460


1.552 0.219 1.344


NOTE: CI, confidence interval; MDR, multidrug resistant; MRSA, methicillin-resistant Staphylococcus aureus; HAI, healthcare-associated


synovial fluid, lymph node. cCulture obtained from a site other than those listed for invasive


infection. aPer 1,000 patient days at risk bCulture obtained from a typically sterile site including blood, bone, bone marrow, cerebrospinal fluid, pleural fluid, peritoneal fluid,


cultures. dUsing algorithm developed by Branch-Elliman et al (2014), culture obtained from sterile site (blood, bone, or device) or patient was treated with MRSA-active antimicrobials in the 5 days prior to or


following the positive culture. ePositive culture not classified as HAI by Branch-Elliman algorithm.


of 10.6 (95% CI, 2.5%–29.4%).20–22 In addition, a study by Eagye et al19 found that the attributable risk of death in patients with healthcare-associated MDR Pseudomonas infec- tions was 22.2%. However, the data used to generate each of these mortality estimates came from single facilities, and in each case, the analyses did not control for confounders in the relationship between infection and mortality. Our estimates for combined invasive and noninvasive positive cultures were lower than these previous estimates in part because we were able to control for confounders including not only post- hospitalization but also preindex events that can increase the risk of HAI and mortality such as surgery, number of days in the ICU, mechanical ventilation, peritoneal dialysis, and hemodialysis. In addition, our detailed microbiology data allowed us to differentiate between invasive and noninvasive positive cultures. A study by Roberts et al23 reported an attributable mortality


rate of 6.5% using data from a single hospital in Chicago. This estimate was calculated by pooling patients with resistant


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