Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-25T07:16:10.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Healthcare-Associated Infection and Hospital Readmission

Published online by Cambridge University Press:  02 January 2015

Carley B. Emerson ,
Lindsay M. Eyzaguirre ,
Jennifer S. Albrecht ,
Angela C. Comer ,
Anthony D. Harris  and
Jon P. Furuno
Carley B. Emerson
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Lindsay M. Eyzaguirre
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Jennifer S. Albrecht
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Angela C. Comer
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Jon P. Furuno*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Pharmacy Practice, Oregon State University and Oregon Health and Science University College of Pharmacy, Portland, Oregon
*
OSU/OHSU College of Pharmacy, Department of Pharmacy Practice, 3303 SW Bond Avenue, Mail Code: CH12C, Portland, OR 97239 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.

Design.

Retrospective cohort study.

Patients and Setting.

Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008.

Methods.

The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results.

Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.

Conclusions.

Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 6 , June 2012 , pp. 539 - 544
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a.

C.B.E. and L.M.E. contributed equally to this article

References

1. Jencks, SF, Williams, MV, Coleman, EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418–1428.Google Scholar
2. Kang, C, Kim, S, Park, W, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 2005;49:760–766.Google Scholar
3. Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
4. Toubes, E, Singh, K, Yin, D, et al. Risk factors for antibiotic-resistant infection and treatment outcomes among hospitalized patients transferred from long-term care facilities: does antimicrobial choice make a difference? Clin Infect Dis 2003;36: 724–730.Google Scholar
5. Harris, A, Furuno, J, Roghmann, M, et al. Targeted surveillance of methicillin-resistant Staphylococcus aureus and its potential use to guide empiric antibiotic therapy. Antimicrob Agents Chemother 2010;54:3143–3148.Google Scholar
6. Furuno, JP, McGregor, JC, Harris, AD, et al. Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166:580–585.Google Scholar
7. Furuno, JP, Harris, AD, Wright, MO, et al. Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2007;28:666–670.Google Scholar
8. Schweizer, ML, Furuno, JP, Harris, AD, et al. Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study. PLoS ONE 2010;5:e11432.Google Scholar
9. ICD-9-CM: International Classification of Diseases, 9th Revision; Clinical Modification, 6th Edition. Vol 1-3. 9th ed. Los Angeles, CA: Practice Management Information; 2006.Google Scholar
10. Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. JClin Epidemiol 1994;47: 1245–1251.Google Scholar
11. 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
12. Cowie, SE, Ma, I, Lee, SK, Smith, RM, Hsiang, YN. Nosocomial MRSA infection in vascular surgery patients: impact on patient outcome. Vase Endovascular Surg 2005;39:327–334.Google Scholar
13. McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, P. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidem 2007;28: 140–145.Google Scholar
14. Anderson, PK, Gill, RD. Cox's regression model for counting processes: a large sample study. Ann Stat 1982;10:1100.Google Scholar
15. Anderson, D, Kaye, K, Chen, L, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS ONE 2009;4:e8305.Google Scholar
16. Chu, LW, Pei, CK. Risk factors for early emergency hospital read-mission in elderly medical patients. Gerontol 1999;45:220–226.Google Scholar
17. Williams, S, Bottle, A, Aylin, P. Length of hospital stay and subsequent emergency readmission. BMJ 2005;331:371.Google Scholar
18. Hasan, O, Meitzer, DO, Shaykevich, SA, et al. Hospital readmis sion in general medicine patients: a prediction model. J Gen Intern Med 2010;25:211–219.Google Scholar
19. Marcantonio, ER, Goldfinger, M, Brennan, TA, McKean, S. Risk factors for unplanned readmission in members of a Medicare HMO. Am J Med 1997;45:P142.Google Scholar
20. Marcantonio, ER, McKean, S, Goldfinger, M, Kleefield, S, Yur-kofsky, M, Brennan, TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. J Am Geriatr Soc 1999;107: 13–17.Google Scholar