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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 ([email protected]).
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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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References

1. Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis 2007;13:1840–1846.CrossRefGoogle ScholarPubMed
2. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
3. Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
4. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
5. Sievert, DM, Ricks, P, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1–14.CrossRefGoogle Scholar
6. Joynt, KE, Jha, AK. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA 2013;309:342–343.Google Scholar
7. Welsh, KJ, Skrobarcek, KA, Abbott, AN, et al. Predictors of relapse of methicillin-resistant Staphylococcus aureus bacteremia after treatment with vancomycin. J Clin Microbiol 2011;49:3669–3672.Google Scholar
8. Fowler, VG, Kong, LK, Corey, GR, et al. Recurrent Staphylococcus aureus bacteremia: pulsed-field gel electrophoresis findings in 29 patients. J Infect Dis 1999;179:1157–1161.Google Scholar
9. Chang, FY, Peacock, JE Jr, Musher, DM, et al. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine 2003;82:333–339.CrossRefGoogle ScholarPubMed
10. Kreisel, K, Boyd, K, Langenberg, P, Roghmann, MC. Risk factors for recurrence in patients with Staphylococcus aureus infections complicated by bacteremia. Diagn Microbiol Infect Dis 2006;55:179–184.Google Scholar
11. Siegman-Igra, Y, Reich, P, Orni-Wasserlauf, R, Schwartz, D, Giladi, M. The role of vancomycin in the persistence or recurrence of Staphylococcus aureus bacteraemia. Scand J Infect Dis 2005;37:572–578.Google Scholar
12. Johnson, LB, Almoujahed, MO, Ilg, K, Maolood, L, Khatib, R. Staphylococcus aureus bacteremia: compliance with standard treatment, long-term outcome and predictors of relapse. Scand J Infect Dis 2003;35:782–789.CrossRefGoogle ScholarPubMed
13. Walker, TM, Bowler, IC, Bejon, P. Risk factors for recurrence after Staphylococcus aureus bacteraemia: a retrospective matched case-control study. J Infect 2009;58:411–416.Google Scholar
14. Wendt, C, Messer, SA, Hollis, RJ, Pfaller, MA, Wenzel, RP, Herwaldt, LA. Recurrent gram-negative bacteremia: incidence and clinical patterns. Clin Infect Dis 1999;28:611–617.Google Scholar
15. Shurland, S, Zhan, M, Bradham, DD, Roghmann, MC. Comparison of mortality risk associated with bacteremia due to methicillin‐resistant and methicillin‐susceptible Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28:273–279.Google Scholar
16. Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
17. Quan, H, Sundararajan, V, Halfon, P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.CrossRefGoogle ScholarPubMed
18. Knaus, WA, Wagner, DP, Draper, EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–1636.CrossRefGoogle ScholarPubMed
19. Wiese, L, Mejer, N, Schønheyder, HC, et al. A nationwide study of comorbidity and risk of reinfection after Staphylococcus aureus bacteraemia. J Infect 2013;67:199–205.Google Scholar
20. Jaliff, BS, Dahl-Knudsen, J, Petersen, A, Skov, R, Benfield, T. Outcome and reinfection after Staphylococcus aureus bacteraemia in individuals with and without HIV-1 infection: a case-control study. BMJ Open 2014;4:e004075.Google Scholar
21. Liu, C, Bayer, A, Cosgrove, SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:285–292.Google Scholar
22. Sakoulas, G, Moise-Broder, PA, Schentag, J, Forrest, A, Moellering, RC, Eliopoulos, GM. Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2004;42:2398–2402.CrossRefGoogle ScholarPubMed
23. Soriano, A, Marco, F, Martínez, JA, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2008;46:193–200.CrossRefGoogle ScholarPubMed