Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study.
Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study.
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DOI：
10.1371/journal.pone.0008305
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发表时间：
2009-12-15
期刊：
影响因子：
3.7
通讯作者：
Sexton DJ
中科院分区：
文献类型：
--
作者：
Anderson DJ;Kaye KS;Chen LF;Schmader KE;Choi Y;Sloane R;Sexton DJ
直接归因于 MRSA 和甲氧西林耐药性的 SSI 的临床和财务结果在很大程度上尚不明确。先前公布的数据提供了相互矛盾的结论。我们对 659 名手术患者进行了多中心匹配结果研究。将 MRSA 引起的 SSI 患者与两组进行比较：匹配的未感染对照患者和 MSSA 引起的 SSI 患者。对 SSI 诊断后 90 天内的四种结果进行了分析：死亡率、再入院、住院时间和住院费用。通过逻辑回归和线性回归确定归因结果。总共有 150 名 MRSA 引起的 SSI 患者与 231 名未感染对照者和 128 名 MSSA 引起的 SSI 患者进行了比较。 MRSA 引起的 SSI 可独立预测 90 天内的再入院（OR = 35.0，95% CI 17.3–70.7）、90 天内的死亡（OR = 7.27，95% CI 2.83–18.7），并导致额外住院 23 天（95% CI 19.7–26.3）和与未感染的对照相比，额外费用为 61,681 美元（95% 23,352–100,011）。甲氧西林耐药性与死亡率增加（OR = 1.72，95% CI 0.70–4.20）和再入院可能性（OR = 0.43，95% CI 0.21–0.89）无关，但与额外住院 5.5 天（95% CI 1.97–9.11）和 24,113 美元相关(95% 4,521–43,704) 额外费用。金黄色葡萄球菌和甲氧西林耐药性对手术患者预后的影响是巨大的。预防一例由 MRSA 引起的 SSI 可为医院节省多达 60,000 美元。
The clinical and financial outcomes of SSIs directly attributable to MRSA and methicillin-resistance are largely uncharacterized. Previously published data have provided conflicting conclusions. We conducted a multi-center matched outcomes study of 659 surgical patients. Patients with SSI due to MRSA were compared with two groups: matched uninfected control patients and patients with SSI due to MSSA. Four outcomes were analyzed for the 90-day period following diagnosis of the SSI: mortality, readmission, duration of hospitalization, and hospital charges. Attributable outcomes were determined by logistic and linear regression. In total, 150 patients with SSI due to MRSA were compared to 231 uninfected controls and 128 patients with SSI due to MSSA. SSI due to MRSA was independently predictive of readmission within 90 days (OR = 35.0, 95% CI 17.3–70.7), death within 90 days (OR = 7.27, 95% CI 2.83–18.7), and led to 23 days (95% CI 19.7–26.3) of additional hospitalization and $61,681 (95% 23,352–100,011) of additional charges compared with uninfected controls. Methicillin-resistance was not independently associated with increased mortality (OR = 1.72, 95% CI 0.70–4.20) nor likelihood of readmission (OR = 0.43, 95% CI 0.21–0.89) but was associated with 5.5 days (95% CI 1.97–9.11) of additional hospitalization and $24,113 (95% 4,521–43,704) of additional charges. The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.
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