Multidrug-Resistant Organisms in Community Hospitals: Initial Trends from the DICON MDRO Biorepository
Methods: The DICON MDRO Biorepository is an ongoing resource that prospectively collects clinically well-characterized samples from MDRO-infected patients hospitalized in community hospitals. For this cohort analysis, we analyzed the first 100 subjects enrolled. Data collected at enrollment included demographic information, previous medical history, social history, culture data, as well as a 90 day follow-up from the time of hospital discharge. Patients under the age of 18 and outpatients were excluded. Data points were collected at the bedside and through a detailed review of each subject’s electronic medical record. Standard descriptive statistics were used.
Results: The average patient age was 61.7 (± 17.7); 49 (49%) were women. Seven patients were concurrently infected with more than one MDRO. The three most common MDROs were C. difficile (n=41, 38%), MRSA (n=41, 38%), and E. coli (n=14, 13%). Multidrug resistant aerobic bacteria caused similar numbers of soft tissue (n=20, 17%), bloodstream (n=19, 17%) and urinary tract infections (n=18, 16%). Co-morbidities such as diabetes (n=43, 43%), current and previous tobacco use (n=65, 65%), and BMI >30 (n=35, 35%) were common. 61 (61%) patients were categorized as having community-onset, community-associated infections; 28 (28%) were classified as hospital-acquired; and 11 (11%) were community-onset, healthcare-associated. 30 (30%) of patients required assistance with more than one ADL upon admission. 5 (5%) patients died and 10 (10%) required admission to the ICU due to infection. The average length of hospitalization was 18 days. For the 66 MDRO-infected patients with complete 90-day follow-up data, 22 (33%) were readmitted to the hospital; 17 (77%) re-admissions were infection related.
Conclusion: Similar to tertiary care centers, C. difficile and MRSA were the most common cause of MDRO infections in community hospitals. Over 75% of patients had community-onset infection. Consequences of MDRO infections in community hospitals such as death and readmission were both severe and frequent.
D. J. Sexton, UpToDate: Editor, Royalties
National Football League: Consultant, Consulting fee and Educational grant
Cubist: Grant Investigator, Grant recipient
Johnson and Johnson: Consultant, Consulting fee
D. Anderson, None
See more of: Poster Abstract Session