Inclusion of 30-day postdischarge detection triples the incidence of hospital-onset methicillin-resistant Staphylococcus aureus.
Inclusion of 30-day postdischarge detection triples the incidence of hospital-onset methicillin-resistant Staphylococcus aureus.
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纳入出院后 30 天检测可使院内发病的耐甲氧西林金黄色葡萄球菌的发病率增加三倍。
DOI：
10.1086/663714
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
Huang,SusanS
中科院分区：
文献类型：
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作者：
Avery,TaliserR;Kleinman,KenP;Klompas,Michael;Aschengrau,Ann;Huang,SusanS
住院患者感染耐甲氧西林金黄色葡萄球菌(MRSA)的风险增加。随着住院时间的缩短，医院获得性MRSA事件可能更容易在出院后被发现。目的我们评估了将出院后30天内发现的MRSA病例归因于最近一次住院治疗的影响，并确定了与出院后MRSA检测相关的患者特征。设计回顾队列研究。设置加利福尼亚州奥兰治县的27家急性护理医院。参与者成人急性护理住院(2002-2007年)。方法使用包含诊断代码的全县医院数据集，每个患者都具有当前入院(POA)指标的MRSA代码。该事件MRSA入院定义为出院前检测到(Pre-DD)医院发病的MRSA(HO-MRSA)，而MRSA不是POA。如果MRSA是POA，并且先前入院时间在30天内，则该先前入院患者被指定为出院后检测(后DD)HO-MRSA。我们使用符号等级检验评估了将DD后HO-MRSA纳入医院HO-MRSA发病率计算的影响，并回顾了医院排名的变化。我们对DD前和DD后HO-MRSA患者的特征进行了多变量比较。结果在1217,253例高危住院患者中，纳入DD后HO-MRSA的医院HO-MRSA发病率是中位数的三倍，从每10,000名高危住院患者中的12.2例增加到35.7例(P<；.0001)。当包括DD后的HO-MRSA时，医院排名发生了实质性变化。住院时间越短的患者发生DD后MRSA的可能性越大。结论在管理索赔数据的基础上，纳入DD后HO-MRSA显著增加了估计的HO-MRSA发生率，并改变了医院排名。这一发现突显了单一机构数据在得出HO-MRSA发病率和排名时的局限性。传染病控制与流行病学杂志2012；33(2)：114-121
BackgroundHospitalized patients are at increased risk for acquisition of methicillin-resistant Staphylococcus aureus (MRSA). As hospital length of stay shortens, hospital-acquired MRSA events may be more likely to be detected after discharge.ObjectiveWe assessed the impact of attributing MRSA cases discovered within 30 days after discharge to the most recent hospitalization and identified patient characteristics associated with MRSA detection after discharge.DesignRetrospective cohort study.SettingTwenty-seven acute care hospitals in Orange County, California.ParticipantsAdult acute care admissions (2002–2007).MethodsUsing a countywide hospital data set containing diagnostic codes with present-on-admission (POA) indicators, we identified the first admission with a MRSA code for each patient. This incident MRSA admission was defined as predischarge-detected (pre-DD) hospital-onset MRSA (HO-MRSA) when MRSA was not POA. If MRSA was POA and a prior admission occurred within 30 days, this prior admission was assigned postdischarge-detected (post-DD) HO-MRSA. We evaluated the impact of including post-DD HO-MRSA in the calculation of hospital HO-MRSA incidence using signed-rank tests and reviewed changes in hospital rankings. We conducted multivariate comparisons of patient characteristics of pre-DD versus post-DD HO-MRSA patients.ResultsAmong 1,217,253 at-risk hospitalizations, the inclusion of post-DD HO-MRSA tripled the median hospital HO-MRSA incidence, from 12.2 to 35.7 cases per 10,000 at-risk admissions (P<.0001). Hospital ranking changed substantially when including post-DD HO-MRSA. Patients with shorter stays were more likely to have post-DD MRSA.ConclusionsOn the basis of administrative claims data, the inclusion of post-DD HO-MRSA significantly increased the estimated HO-MRSA incidence and altered hospital rankings. This finding underscores the limitations of single-facility data when deriving HO-MRSA incidence and rank.Infect Control Hosp Epidemiol 2012;33(2):114-121