title: The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals.
abstract: BACKGROUND
  Data regarding the epidemiology, treatment, and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) infections in rural and community hospitals are limited.
  
  
  METHODS
  This cohort study was conducted at 1 tertiary care hospital and 8 community hospitals in the southeastern United States. Patients with a surgical site infection (SSI) and/or bacteremia due to MRSA were prospectively identified at each study hospital during the period 1994-2003.
  
  
  RESULTS
  A total of 129 patients with SSI and 564 patients with bacteremia due to MRSA were identified. Only 57 patients with SSI (44.2%) received antibiotics active against MRSA on the initial date of diagnosis; only 95 (73.6%) received an agent active against MRSA by day 7 after diagnosis of SSI due to MRSA. Ninety-five patients with SSI due to MRSA (73.6%) were readmitted to the hospital within 90 days after their original surgery. The 1-year mortality rate among patients with SSI due to MRSA was 22%. Inadequate therapy was also commonly given to patients with bacteremia: only 216 (38.3%) received antibiotics active against MRSA on the initial day of infection, and only 383 (67.9%) received an agent active against MRSA by day 7 after diagnosis. Approximately one-third of patients with bloodstream infection died during their initial hospitalization. Patients hospitalized in community hospitals were less likely to receive effective antimicrobial therapy on both the day of infection and within 7 days after infection, compared with patients in the tertiary care hospital.
  
  
  CONCLUSIONS
  Inadequate therapy is commonly administered after diagnosis of SSI and bacteremia due to MRSA in patients in community hospitals.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. keith.kaye@duke.edu
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.forename: Yong
authors.initials: Y
authors.lastname: Choi
authors.forename: Katherine
authors.initials: K
authors.lastname: Link
authors.forename: Paul
authors.initials: P
authors.lastname: Thacker
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011446:Prospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents