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Determination of Risk Factors for Recurrent Methicillin-Resistant Staphylococcus aureus Bacteremia in a Veterans Affairs Healthcare System Population

Published online by Cambridge University Press:  16 February 2015

Justin Albertson ,
Jennifer S. McDanel ,
Ryan Carnahan ,
Elizabeth Chrischilles ,
Eli N. Perencevich ,
Michihiko Goto ,
Lan Jiang ,
Bruce Alexander  and
Marin L. Schweizer
Justin Albertson
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Jennifer S. McDanel
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Ryan Carnahan
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Elizabeth Chrischilles
Affiliation:
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Eli N. Perencevich
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Michihiko Goto
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Lan Jiang
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Bruce Alexander
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Marin L. Schweizer*
Affiliation:
Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
*
Address correspondence to Marin L. Schweizer, PhD, Center for Comprehensive Access and Delivery Research and Evaluation, Mailstop 152, Iowa City Veterans Affairs Medical Center, Iowa City, IA 52246 (marin-schweizer@uiowa.edu).
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Abstract

OBJECTIVE

To identify important risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) to assist clinicians in identifying high-risk patients for continued surveillance and follow-up.

METHODS

In this retrospective cohort study, we examined patients with MRSA bacteremia at 122 Veterans Affairs medical facilities from January 1, 2003, through December 31, 2010. Recurrent MRSA bacteremia was identified by a positive blood culture result from 2 to 180 days after index hospitalization discharge. Subset analyses were performed to evaluate risk factors for early-onset (2–60 days after discharge) and late-onset (61–180 days after discharge) recurrence. Risk factors were evaluated using Cox proportional hazards regression.

RESULTS

Of 18,425 patients, 1,159 (6.3%) had recurrent MRSA bacteremia. The median time to recurrence was 63 days. Longer duration of index bacteremia, increased severity of illness, receipt of only vancomycin, community-acquired infection, and several comorbidities were risk factors for recurrence. Congestive heart failure, hypertension, and rheumatoid arthritis/collagen disease were risk factors for early-onset but not late-onset recurrence. Geographic region and cardiac arrhythmias were risk factors for late-onset but not early-onset recurrence.

CONCLUSIONS

Risk factors for recurrent MRSA bacteremia included comorbidities, severity of illness, duration of bacteremia, and receipt of only vancomycin. Awareness of risk factors may be important at patient discharge for implementation of quality improvement initiatives including surveillance, follow-up, and education for high-risk patients.

Infect Control Hosp Epidemiol 2015;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 5 , May 2015 , pp. 543 - 549
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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