559. Post Discharge Mortality Among Patients Hospitalized With MRSA Colonization And/Or Infection
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011 Poster.pdf (4.7 MB)
  • Background: 

    In January 2007, the Veterans Health Administration (VHA) issued the Methicillin resistant Staphylococcus aureus (MRSA) Directive to reduce the transmission of MRSA in the acute care setting of Veterans Affairs (VA) hospitals using active surveillance through nasal screening, Contact Precaution Isolation, and hand hygiene.

    Methods: 

    Nasal swabs from hospital admission and transfers are screened by PCR; discharge swabs are screened using CHROMAgar.  We conducted prospective surveillance of all true infections due to MRSA beginning in September 2007.  We examined post discharge mortality with at least 18 months of follow up for patients who were hospitalized and had positive nasal discharge cultures colonized with MRSA from Oct, 2007 through July, 2009.  Our multivariable analysis included 19 potential predictors of death.

    Results: During this period, 762 patients were hospitalized with culture-proven MRSA colonization and/or infection.  Of these, 198 patients were hospitalized with an MRSA infection.  The overall post discharge mortality for patients who were hospitalized with MRSA infection was 79 (39.8%)/198, which was significantly higher than colonized patients who were hospitalized without an MRSA infection 150(26.6%)/564, p< 0.001 chi-sq test.  Logistic regression analysis showed that an MRSA infection, white (vs. black) race, hemodialysis, cancer, hospitalization as a medical (vs. surgical) patient, previous hospitalization within 8 years of study hospitalization, and positive admission nasal screen for MRSA were independent predictors of mortality. 

    Conclusion: Our data suggest that for hospitalized patients who were discharged with a positive MRSA nasal culture, admission colonization with MRSA (a possible marker for persistent MRSA colonization) was associated with a high mortality controlling for other comorbidities.  Among those who were MRSA colonized, patients who were hospitalized with an MRSA infection had even higher overall mortality. 


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Akshay Sharma, MBBS1, Rogers Chantrice, MPH2, Courtney Stafford, MPH2, David Rimland, MD2,3 and Robert Gaynes, MD2,3, (1)Emory University Rollins School of Public Health, Atlanta, GA, (2)Atlanta VA Medical Center, Decatur, GA, (3)Emory University School of Medicine, Decatur, GA

    Disclosures:

    A. Sharma, None

    R. Chantrice, None

    C. Stafford, None

    D. Rimland, None

    R. Gaynes, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.