title: Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection.
abstract: Data for 479 patients were analyzed to assess the impact of methicillin resistance on the outcomes of patients with Staphylococcus aureus surgical site infections (SSIs). Patients infected with methicillin-resistant S. aureus (MRSA) had a greater 90-day mortality rate than did patients infected with methicillin-susceptible S. aureus (MSSA; adjusted odds ratio, 3.4; 95% confidence interval, 1.5-7.2). Patients infected with MRSA had a greater duration of hospitalization after infection (median additional days, 5; P<.001), although this was not significant on multivariate analysis (P=.11). Median hospital charges were 29,455 dollars for control subjects, 52,791 dollars for patients with MSSA SSI, and 92,363 dollars for patients with MRSA SSI (P<.001 for all group comparisons). Patients with MRSA SSI had a 1.19-fold increase in hospital charges (P=.03) and had mean attributable excess charges of 13,901 dollars per SSI compared with patients who had MSSA SSIs. Methicillin resistance is independently associated with increased mortality and hospital charges among patients with S. aureus SSI.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. john.engemann@duke.edu
authors.forename: John J
authors.initials: JJ
authors.lastname: Engemann
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Melissa Z
authors.initials: MZ
authors.lastname: Bronstein
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Trivette
authors.forename: Jane P
authors.initials: JP
authors.lastname: Briggs
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D005260:Female; D013502:General Surgery; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus