title: Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study.
abstract: BACKGROUND
  The clinical and financial outcomes of SSIs directly attributable to MRSA and methicillin-resistance are largely uncharacterized. Previously published data have provided conflicting conclusions.
  
  
  METHODS
  We conducted a multi-center matched outcomes study of 659 surgical patients. Patients with SSI due to MRSA were compared with two groups: matched uninfected control patients and patients with SSI due to MSSA. Four outcomes were analyzed for the 90-day period following diagnosis of the SSI: mortality, readmission, duration of hospitalization, and hospital charges. Attributable outcomes were determined by logistic and linear regression.
  
  
  RESULTS
  In total, 150 patients with SSI due to MRSA were compared to 231 uninfected controls and 128 patients with SSI due to MSSA. SSI due to MRSA was independently predictive of readmission within 90 days (OR = 35.0, 95% CI 17.3-70.7), death within 90 days (OR = 7.27, 95% CI 2.83-18.7), and led to 23 days (95% CI 19.7-26.3) of additional hospitalization and $61,681 (95% 23,352-100,011) of additional charges compared with uninfected controls. Methicillin-resistance was not independently associated with increased mortality (OR = 1.72, 95% CI 0.70-4.20) nor likelihood of readmission (OR = 0.43, 95% CI 0.21-0.89) but was associated with 5.5 days (95% CI 1.97-9.11) of additional hospitalization and $24,113 (95% 4,521-43,704) of additional charges.
  
  
  CONCLUSIONS
  The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Duke Infection Control Outreach Network, Durham, North Carolina, USA.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.forename: Luke F
authors.initials: LF
authors.lastname: Chen
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
authors.forename: Yong
authors.initials: Y
authors.lastname: Choi
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
mesh_terms: D016022:Case-Control Studies; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000150:complications* / Q000191:economics* / Q000401:mortality; D013530:Surgical Wound Infection / Q000150:complications* / Q000191:economics* / Q000401:mortality; D016019:Survival Analysis