MRSA tied to higher readmission rate, mortality than MSSA

  • Inagaki K & al.
  • Clin Infect Dis
  • 14 Feb 2019

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Patients surviving Staphylococcus aureus infections have almost 25% odds of readmission.
  • Methicillin-resistant S aureus (MRSA) bacteremia is associated with recurrent bacteremia (especially in concurrent endocarditis), hospital readmission, increased length of stay (LOS), and in-hospital mortality.

Why this matters

  • Monitor patients with endocarditis carefully to reduce treatment failure.
  • Optimize management in patients with comorbid, high-risk conditions most associated with readmission.

Key results

  • 92,089 (standard error [SE] 1905) S aureus bacteremia cases; 48.5% (44,653 cases, SE 1030) had MRSA bacteremia.
  • All-cause 30-day readmission among S aureus patients: 22%.
  • Patients with MRSA were 17% likelier to have 30-day readmission with S aureus bacteremia recurrence (HR, 1.17; 95% CI, 1.02-1.34) vs those with methicillin-susceptible S aureus (MSSA).
  • Coexisting index endocarditis was associated with 30-day readmission (HR, 1.44; 95% CI, 1.21-1.72; P<.001>
  • Patients with MRSA bacteremia had 15% greater odds of in-hospital death (OR, 1.15; 95% CI, 1.07-1.23), as well as longer LOS (incidence rate ratio, 1.09; 95% CI, 1.06-1.11) vs MSSA patients.

Study design

  • Retrospective analysis evaluating population-based estimates of 30-day readmission due to S aureus by methicillin susceptibility, mortality, LOS.
  • Funding: No external funding.

Limitations

  • ICD-9-CM coding bias.
  • Selection bias.
  • Readmission bias.
  • Lack of data on link between prostheses and infection.
  • Residual confounding.