1208. Impact of Admission to an Inpatient Infectious Disease Unit on Methicillin-resistant Staphylococcus aureus Bloodstream Infections
Session: Poster Abstract Session: Healthcare Epidemiology: MSSA, MRSA and Other Gram Positive Infections
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • revised impact of admission 9.27.jpg (334.1 kB)
  • Background:

    Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) remains a condition with high mortality. Despite the introduction of new antibiotics, the mortality in the past 10 years at our institution remains unchanged. To evaluate measures that improve outcomes in these patients (pts), we studied the impact of admission to an inpatient infectious disease (ID) unit.

    Methods:

    We identified a retrospective cohort of pts with MRSA BSI at an 800-bed hospital in urban Detroit from 1-2013 to 2-2017. Pts were assigned to one of the 3 groups: group 1 was admission to inpatient ID unit where the ID doctors were the attending physicians, group 2 was ID consultation (without admission to ID unit) and group 3 was no ID consultation. Demographics, clinical information and 30 day mortality from index blood culture were collected. Source of BSI was classified into 4 categories: primary (endovascular infection); secondary (respiratory, skin, osteomyelitis, abdominal and genitourinary infections); central line associated; unknown. Unpaired t-test and Fisher’s exact test were used to compare groups.

    Results:

    A total of 477 pts were identified with MRSA BSI during the study period. 89 (18.7%) were in group 1, 299 (62%) in group 2 and 89 (18.7%) in group 3. Pt clinical characteristics and outcomes are shown in Table 1. Overall 30-day mortality was 21.4%. Comparison of mortality between groups are shown in Table 2.

    Conclusion:

    While it is well established that ID consultation has improved outcomes in MRSA BSI, this is the first study that shows that admission to an inpatient ID unit decreases mortality even further.

    Table 1. Patient clinical characteristics and outcomes

    Group 1

    N=89 (%)

    Group 2

    N=299 (%)

    Group 3

    N=89 (%)

    Age mean (±SD)

    51.53 (17.58)

    62.86 (17.47)

    64.6 (17.60)

    Male

    48 (53.9)

    186 (62.2)

    61 (68.5)

    Mean duration of BSI (±SD)

    3.19 (2.502)

    3.09 (2.525)

    2.94 (2.503)

    Source

    Primary

    Secondary

    Central line associated

    Unknown

    17 (19.5)

    48 (55.2)

    10 (11.5)

    12 (13.8)

    26 (8.9)

    138 (47.1)

    60 (20.5)

    69 (23.5)

    7 (7.9)

    41 (46.1)

    14 (15.7)

    27 (30.3)

    30 day mortality

    8 (9.0)

    54 (18.2)

    40 (44.9)

    Readmission

    14 (16.7)

    42 (15.4)

    16 (18.0)

    Recurrence

    10 (11.2)

    13 (4.8)

    5 (5.6)

    Table 2. Comparison of 30-day mortality between groups

    P value

    Group 1 vs group 2

    0.0383

    Group 2 vs group 3

    p <0.0001

    Group 1 vs group 3

    p <0.0001

    Zainab Farooqui Mirza, MBBS MD1, Ana C. Bardossy, MD2, Helina Misikir, MPH3, Hind Hadid, MD4, Nathalie Baratz, MD5, Hira Rizvi, MD6, Erica Herc, MD4, Anne Chen, MD7 and Marcus Zervos, MD6, (1)Infectious Diseases, Henry Ford Health System, Detroit, MI, (2)Division of Infectious Disease, Henry Ford Health System, Detroit, MI, (3)Henry Ford Hospital, Detroit, MI, (4)Infectious Disease, Henry Ford Health System, Detroit, MI, (5)Infectious Disease, Henry Ford Health System, Detriot, MI, (6)Henry Ford Health System, Detroit, MI, (7)Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI

    Disclosures:

    Z. Farooqui Mirza, None

    A. C. Bardossy, None

    H. Misikir, None

    H. Hadid, None

    N. Baratz, None

    H. Rizvi, None

    E. Herc, None

    A. Chen, None

    M. Zervos, None

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