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Multicenter Study
. 2009 Dec 15;4(12):e8305.
doi: 10.1371/journal.pone.0008305.

Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study

Deverick J Anderson  1 , Keith S Kaye, Luke F Chen, Kenneth E Schmader, Yong Choi, Richard Sloane, Daniel J Sexton
Affiliations
Multicenter Study

Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study

Deverick J Anderson et al. PLoS One. .

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.

Methodology: 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.

Principal findings: 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/significance: 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.

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Conflict of interest statement

Competing Interests: DJA has received research support from Pfizer, Inc. and Merck and Co., Inc. and has previously served on the speaker's bureau for Cubist.

Figures

Figure 1
Figure 1. Survival analysis of cases and controls.
Kaplan-Meier Survival Analysis of mortality among patients with surgical site infection (SSI) due to methicillin resistant Staphylcoccus aureus, SSI due to methicillin-susceptible S. aureus, and uninfected controls.
See this image and copyright information in PMC

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