title: Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities.
abstract: OBJECTIVE
  To assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital.
  
  
  METHODS
  Retrospective multiple-cohort study of adults discharged from 1 hospital in 2005-2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers.
  
  
  RESULTS
  We evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N=121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P<.01).
  
  
  CONCLUSIONS
  Patients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed.
authors.affiliation: 1Department of Internal Medicine,Yale School of Medicine,New Haven,Connecticut.
authors.forename: Rupak
authors.initials: R
authors.lastname: Datta
authors.affiliation: 3Pittsburgh Supercomputing Center,Carnegie Mellon University,Pittsburgh,Pennsylvania.
authors.forename: Shawn
authors.initials: S
authors.lastname: Brown
authors.affiliation: 4Department of Statistics,University of California Irvine,Irvine,California.
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.affiliation: 2Division of Infectious Diseases and Health Policy Research Institute,University of California Irvine School of Medicine,Irvine,California.
authors.forename: Chenghua
authors.initials: C
authors.lastname: Cao
authors.affiliation: 2Division of Infectious Diseases and Health Policy Research Institute,University of California Irvine School of Medicine,Irvine,California.
authors.forename: John
authors.initials: J
authors.lastname: Billimek
authors.affiliation: 5Department of Population Medicine,Harvard Medical School and Harvard Pilgrim Healthcare Institute,Boston,Massachusetts.
authors.forename: Taliser
authors.initials: T
authors.lastname: Avery
authors.affiliation: 6Global Obesity Prevention Center,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.affiliation: 2Division of Infectious Diseases and Health Policy Research Institute,University of California Irvine School of Medicine,Irvine,California.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002140:California; D002353:Carrier State; D003013:Clostridium / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents