hai mortality—mdr gram-negative bacteria and mrsa 853
figure 1. Risk differences for attributable mortality 30 and 90 days post-culture for patients with a positive culture relative to patients without a positive culture Abbreviations: MDR=multi-drug resistant, RR=risk ratio, CI=confidence interval, HAI=healthcare-associated infection, MRSA=methicillin-resistant Staphylococcus aureus. Definitions: Gram-negative Invasive=culture obtained from a typically sterile site including blood, bone, bone marrow, cerebrospinal fluid, pleural fluid, peritoneal fluid, synovial fluid, lymph node, Gram-negative Non-invasive=culture obtained from a site other than those listed for invasive, MRSA HAI=using 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, MRSA colonization=positive culture not classified as HAI by Branch-Elliman algorithm
infections due to a number of different organisms (including Staphylococcus aureus, Enterobacter, Pseudomonas, Klebsiella, or Acinetobacter) and the statistical analyses controlled for a number of important confounders including the Acute Phy- siology and Chronic Health Evaluation (APACHE) III score as calculated during the first 24 hours of hospitalization. Our study improves upon this estimate in several important ways. First, because our data came from more than 100 hospitals throughout the United States, we had a sufficient sample size to calculate organism-specific mortality estimates. Second, our data allowed us to follow patients postdischarge. And finally, although we were unable to calculate physiology-based severity of illness scores (eg, APACHE), we included a number of important additional covariates in our model along with an
estimate of the comorbidity burden (the Charlson and Elixhauser hybrid index). It is well-known that a substantial proportion of US veterans
who receive care through the VA system also receive care through other healthcare systems.24–26 A recent paper demonstrated that surgical patients who were readmitted to a different hospital than the one at which their surgery was performed were at higher risk for mortality compared to those who were readmitted to the same hospital.27 Given that many of the patients in our analysis had outside insurance, future research should examine the impact of care coordination between different healthcare systems on mortality risks among those with infections due to MDR gram-negative bacteria or MRSA.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136
