Surgical site infections: Causative pathogens and associated outcomes

• Published in: American journal of infection control Vol. 38; no. 2; pp. 112 - 120
• Main Authors: Weigelt, John A., MD, DVM, Lipsky, Benjamin A., MD, Tabak, Ying P., PhD, Derby, Karen G., BA, Kim, Myoung, PhD, Gupta, Vikas, PharmD, BCPS
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.2010; Elsevier; Mosby-Year Book, Inc
• Subjects: Aged; Bacterial diseases; Biological and medical sciences; Cost of Illness; Drug resistance; Epidemiology. Vaccinations; Female; General aspects; hospital costs; hospital length of stay; hospital mortality; Human bacterial diseases; Human infectious diseases. Experimental studies and models; Humans; Infection Control; Infectious Disease; Infectious diseases; Length of Stay; Male; Medical sciences; methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Morbidity; Mortality; outcomes research; Risk factors; Staphylococcal Infections - drug therapy; Staphylococcal Infections - economics; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus infections; Surgical site infection; Surgical Wound Infection - drug therapy; Surgical Wound Infection - economics; Surgical Wound Infection - microbiology; Surgical Wound Infection - mortality; Treatment Outcome; United States; United States; Surgical site infection; methicillin-resistant Staphylococcus aureus; hospital length of stay; outcomes research; hospital costs; hospital mortality; Surgical wound; Nosocomial infection; Costs; Prognosis; Mortality; Check; Infection; Prevention; Health economy; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Hospital; Staphylococcal infection; Public health; Staphylococcus aureus
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.06.010

Background Surgical site infections (SSIs) are associated with substantial morbidity, mortality, and cost. Few studies have examined the causative pathogens, mortality, and economic burden among patients rehospitalized for SSIs. Methods From 2003 to 2007, 8302 patients were readmitted to 97 US hospitals with a culture-confirmed SSI. We analyzed the causative pathogens and their associations with in-hospital mortality, length of stay (LOS), and cost. Results The proportion of methicillin-resistant Staphylococcus aureus (MRSA) significantly increased among culture-positive SSI patients during the study period (16.1% to 20.6%, respectively, P < .0001). MRSA (compared with other) infections had higher raw mortality rates (1.4% vs 0.8%, respectively, P = .03), longer LOS (median, 6 vs 5 days, respectively, P < .0001), and higher hospital costs ($7036 vs $6134, respectively, P < .0001). The MRSA infection risk-adjusted attributable LOS increase was 0.93 days (95% confidence interval [CI]: 0.65-1.21; P < .0001), and cost increase was $1157 (95% CI: $641-$1644; P < .0001). Other significant independent risk factors increasing cost and LOS included illness severity, transfer from another health care facility, previous admission (<30 days), and other polymicrobial infections ( P < .05). Conclusion SSIs caused by MRSA increased significantly and were independently associated with economic burden. Admission illness severity, transfer from another health care setting, and recent hospitalization were associated with higher mortality, increased LOS, and cost.