title: Prevalence, predictors, and outcomes of methicillin-resistant Staphylococcus aureus infections in patients undergoing major surgical procedures in the United States: a population-based study.
abstract: BACKGROUND
  National estimates of methicillin-resistant Staphylococcus aureus (MRSA) infection rates in hospitalized surgical patients and outcomes are lacking. We sought to estimate the prevalence, identify the predictors, and describe the outcomes of MRSA infections in hospitalized patients undergoing major surgical procedures (MSPs) in the United States.
  
  
  METHODS
  We performed a retrospective analysis of the Nationwide Inpatient Sample, the largest all-payer hospital discharge database in the United States, for the years 2009 to 2010.
  
  
  RESULTS
  Of the 22,932,948 hospitalizations that had an MSP, MRSA infection occurred in 235,636 (1.03%) patients. Factors associated with "significantly" lower risk of MRSA occurrence include women (odds ratio [OR] .68), elective procedure (OR .38), teaching institutes (OR .94), and large hospital size (OR .87). Blacks (OR 1.19), native Americans (OR 1.27), increased comorbid burden (OR 1.38), and uninsured patients were associated with higher risk of MRSA occurrence. Outcomes in MSPs "with" MRSA versus "without" MRSA include mean length of stay (14 vs 5 days) and in-hospital mortality (IHM) rate (3.7% vs 1.2%). Occurrence of an MRSA was associated with significantly longer length of stay and higher odds of IHM (OR 1.39, 95% confidence interval 1.30 to 1.48).
  
  
  CONCLUSIONS
  Although the occurrence of MRSA infections complicating MSPs was low, it is associated with worse outcomes. Certain predictors of MRSA infection are identified.
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, USA. Electronic address: Veerajalandhar.Allareddy@UHhospitals.org.
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Ashima
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Min Kyeong
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Dental Medicine, Harvard University, Boston, MA, USA.
authors.forename: Romesh P
authors.initials: RP
authors.lastname: Nalliah
authors.affiliation: Health Services Research & Policy, University of Nebraska, Omaha, NE 68198, USA.
authors.forename: Sankeerth
authors.initials: S
authors.lastname: Rampa
authors.affiliation: Department of Orthodontics, University of Iowa, Iowa City, IA, USA.
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Department of Pediatric Critical Care, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Rotta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology* / Q000628:therapy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000628:therapy; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Hospital-acquired infections—epidemiology; MRSA; Outcomes research; Surgical procedures