Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection.
Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk patients in the year following detection.
复制标题
检测后一年，高危患者的金黄色葡萄球菌感染和住院。
DOI：
10.1371/journal.pone.0024340
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Platt R
中科院分区：
文献类型：
--
作者：
Huang SS;Hinrichsen VL;Datta R;Spurchise L;Miroshnik I;Nelson K;Platt R
许多研究评估了单次住院和随后再次入院时耐甲氧西林金黄色葡萄球菌（MRSA）感染的情况。没有人评估出院后MRSA感染的综合负担，同时考虑到各机构的医疗保健利用。我们对1991年1月至2003年12月在三级医疗中心新发现携带MRSA的哈佛朝圣者医疗保险的成年患者进行了回顾性队列研究。我们评估了所有MRSA引起的感染与新检测后一年内住院相关，无论医院位置如何。收集了关于合并症、医疗保健利用、死亡率和MRSA结局的数据。在591名新检测到的MRSA携带者中，23%被定植，77%在检测时被感染。在检测后的一年中，196例（33%）患者发生了317例离散和不相关的MRSA感染。最常见的感染是肺炎（34%）、软组织（27%）和原发性血流（18%）感染。感染发生在检测后的中位时间为56天。在所有感染中，26%涉及菌血症，17%导致MRSA可归因的死亡。在新检测到MRSA的住院期间，14%（82/576）发生了后续感染。在存活出院的患者中，24%（114/482）在检测后的一年内发生了出院后感染。一半（99/185，54%）的出院后感染导致再入院，大多数（104/185，55%）发生在出院后90天以上。在高风险的三级护理患者中，新检测到的MRSA携带者在获得后的一年中具有很大的感染风险和相当大的归因死亡率。大多数感染发生在出院后，18%与再入院相关的感染发生在新检测到MRSA的医院以外的医院。尽管在减少住院期间的MRSA感染方面取得了进展，但危重病和慢性病携带者的MRSA感染风险在出院后仍然存在，需要有针对性的预防策略。
Many studies have evaluated methicillin-resistant Staphylococcus aureus (MRSA) infections during single hospitalizations and subsequent readmissions to the same institution. None have assessed the comprehensive burden of MRSA infection in the period after hospital discharge while accounting for healthcare utilization across institutions. We conducted a retrospective cohort study of adult patients insured by Harvard Pilgrim Health Care who were newly-detected to harbor MRSA between January 1991 and December 2003 at a tertiary care medical center. We evaluated all MRSA-attributable infections associated with hospitalization in the year following new detection, regardless of hospital location. Data were collected on comorbidities, healthcare utilization, mortality and MRSA outcomes. Of 591 newly-detected MRSA carriers, 23% were colonized and 77% were infected upon detection. In the year following detection, 196 (33%) patients developed 317 discrete and unrelated MRSA infections. The most common infections were pneumonia (34%), soft tissue (27%), and primary bloodstream (18%) infections. Infections occurred a median of 56 days post-detection. Of all infections, 26% involved bacteremia, and 17% caused MRSA-attributable death. During the admission where MRSA was newly-detected, 14% (82/576) developed subsequent infection. Of those surviving to discharge, 24% (114/482) developed post-discharge infections in the year following detection. Half (99/185, 54%) of post-discharge infections caused readmission, and most (104/185, 55%) occurred over 90 days post-discharge. In high-risk tertiary care patients, newly-detected MRSA carriage confers large risks of infection and substantial attributable mortality in the year following acquisition. Most infections occur post-discharge, and 18% of infections associated with readmission occurred in hospitals other than the one where MRSA was newly-detected. Despite gains in reducing MRSA infections during hospitalization, the risk of MRSA infection among critically and chronically ill carriers persists after discharge and warrants targeted prevention strategies.