title: Determination of risk factors for recurrent methicillin-resistant Staphylococcus aureus bacteremia in a Veterans Affairs healthcare system population.
abstract: OBJECTIVE
  To identify important risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) to assist clinicians in identifying high-risk patients for continued surveillance and follow-up.
  
  
  METHODS
  In this retrospective cohort study, we examined patients with MRSA bacteremia at 122 Veterans Affairs medical facilities from January 1, 2003, through December 31, 2010. Recurrent MRSA bacteremia was identified by a positive blood culture result from 2 to 180 days after index hospitalization discharge. Subset analyses were performed to evaluate risk factors for early-onset (2-60 days after discharge) and late-onset (61-180 days after discharge) recurrence. Risk factors were evaluated using Cox proportional hazards regression.
  
  
  RESULTS
  Of 18,425 patients, 1,159 (6.3%) had recurrent MRSA bacteremia. The median time to recurrence was 63 days. Longer duration of index bacteremia, increased severity of illness, receipt of only vancomycin, community-acquired infection, and several comorbidities were risk factors for recurrence. Congestive heart failure, hypertension, and rheumatoid arthritis/collagen disease were risk factors for early-onset but not late-onset recurrence. Geographic region and cardiac arrhythmias were risk factors for late-onset but not early-onset recurrence.
  
  
  CONCLUSIONS
  Risk factors for recurrent MRSA bacteremia included comorbidities, severity of illness, duration of bacteremia, and receipt of only vancomycin. Awareness of risk factors may be important at patient discharge for implementation of quality improvement initiatives including surveillance, follow-up, and education for high-risk patients.
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Justin
authors: J
authors: Albertson
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Jennifer S
authors: JS
authors: McDanel
authors: 2Department of Epidemiology,University of Iowa College of Public Health,Iowa City,Iowa.
authors: Ryan
authors: R
authors: Carnahan
authors: 2Department of Epidemiology,University of Iowa College of Public Health,Iowa City,Iowa.
authors: Elizabeth
authors: E
authors: Chrischilles
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Eli N
authors: EN
authors: Perencevich
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Michihiko
authors: M
authors: Goto
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Lan
authors: L
authors: Jiang
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Bruce
authors: B
authors: Alexander
authors: 1Center for Comprehensive Access and Delivery Research and Evaluation,Iowa City Veterans Affairs Medical Center,Iowa City,Iowa.
authors: Marin L
authors: ML
authors: Schweizer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D055815:Young Adult