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Inclusion of 30-Day Postdischarge Detection Triples the Incidence of Hospital-Onset Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Taliser R. Avery ,
Ken P. Kleinman ,
Michael Klompas ,
Ann Aschengrau  and
Susan S. Huang
Taliser R. Avery*
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Ken P. Kleinman
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Ann Aschengrau
Affiliation:
Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, Irvine, California
*
Department of Population Medicine, Harvard Medical School and HPHC Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 (taliser_avery@hphc.org)
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Abstract

Background.

Hospitalized 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.

Objective.

We 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.

Design.

Retrospective cohort study.

Setting.

Twenty-seven acute care hospitals in Orange County, California.

Participants.

Adult acute care admissions (2002–2007).

Methods.

Using 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.

Results.

Among 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.

Conclusions.

On 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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 114 - 121
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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