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Mortality associated with in-hospital bacteraemia caused by Staphylococcus aureus: a multistate analysis with follow-up beyond hospital discharge
- Source :
- The Journal of antimicrobial chemotherapy. 66(2)
- Publication Year :
- 2010
-
Abstract
- The main objective was to study the impact of in-hospital bacteraemia caused by Staphylococcus aureus on mortality within 90 days after admission. We compared methicillin-resistant S. aureus (MRSA) with methicillin-susceptible S. aureus (MSSA).The study population consisted of adult residents of Tayside, Scotland, UK, from 1 January 2005 to 30 September 2006 who had a new admission to Ninewells Hospital between 1 July 2005 and 30 June 2006. All patients (n = 3132) in the same wards as the patients infected with S. aureus were included. We addressed key weaknesses in previous studies by using a cohort design and applying a multistate model, which addressed the temporal dynamics. Critically, the model recognized that death and discharge from the hospital are competing events and that delay in discharge independently increases the risk of death.The cohort included 3132 patients, of whom 494 died within 90 days after admission, 34 developed MRSA bacteraemia and 26 MSSA bacteraemia in the hospital. In comparison with patients without S. aureus bacteraemia, the death hazard was 5.6 times greater with MRSA [95% confidence interval (CI) 3.36-9.41] and 2.7 times greater with MSSA bacteraemia (95% CI 1.33-5.39). After adjustment for co-morbidity, hospitalization, age and sex, the death hazard was 2.9 times greater with MRSA (95% CI 1.70-4.88) and 1.7 times greater with MSSA bacteraemia (95% CI 0.84-3.47).Time-dependent models such as the proposed multistate model are necessary to address the temporal dynamics of admission, infection, discharge and death. The impact of S. aureus bacteraemia on mortality should be considered on two levels: the burden of disease, i.e. nosocomial infection with S. aureus bacteraemia, and the burden of resistance to methicillin.
- Subjects :
- Microbiology (medical)
Adult
Male
congenital, hereditary, and neonatal diseases and abnormalities
medicine.medical_specialty
Staphylococcus aureus
medicine.medical_treatment
Bacteremia
medicine.disease_cause
law.invention
law
Internal medicine
Drug Resistance, Bacterial
Medicine
Humans
Pharmacology (medical)
Survival analysis
Aged
Pharmacology
Aged, 80 and over
Cross Infection
business.industry
Length of Stay
Middle Aged
Staphylococcal Infections
bacterial infections and mycoses
medicine.disease
Methicillin-resistant Staphylococcus aureus
Intensive care unit
Confidence interval
Patient Discharge
Surgery
Anti-Bacterial Agents
Hospitalization
Infectious Diseases
Scotland
Cohort
Regression Analysis
Female
Methicillin Resistance
Hemodialysis
business
Methicillin Susceptible Staphylococcus Aureus
Follow-Up Studies
Subjects
Details
- ISSN :
- 14602091
- Volume :
- 66
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- The Journal of antimicrobial chemotherapy
- Accession number :
- edsair.doi.dedup.....9106178de3f02cde46bd06d6475f2b38