Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T00:45:06.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Readmissions With Multidrug-Resistant Infection in Patients With Prior Multidrug Resistant Infection

Published online by Cambridge University Press:  18 December 2017

Jason P. Burnham ,
Jennie H. Kwon ,
Margaret A. Olsen ,
Hilary M. Babcock  and
Marin H. Kollef
Jason P. Burnham*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Jennie H. Kwon
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Margaret A. Olsen
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Hilary M. Babcock
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Marin H. Kollef*
Affiliation:
Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri
*
Address correspondence to Jason P. Burnham, MD, Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110 ([email protected]) or to Marin H. Kollef, MD, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St Louis, MO 63110 ([email protected]).
Address correspondence to Jason P. Burnham, MD, Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St Louis, MO 63110 ([email protected]) or to Marin H. Kollef, MD, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St Louis, MO 63110 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine incidence of and risk factors for readmissions with multidrug-resistant organism (MDRO) infections among patients with previous MDRO infection.

DESIGN

Retrospective cohort of patients admitted between January 1, 2006, and October 1, 2015.

SETTING

Barnes-Jewish Hospital, a 1,250-bed academic tertiary referral center in St Louis, Missouri.

METHODS

We identified patients with MDROs obtained from the bloodstream, bronchoalveolar lavage (BAL)/bronchial wash, or other sterile sites. Centers for Disease Control and prevention (CDC) and European CDC definitions of MDROs were utilized. All readmissions ≤1 year from discharge from the index MDRO hospitalization were evaluated for bloodstream, BAL/bronchial wash, or other sterile site cultures positive for the same or different MDROs.

RESULTS

In total, 4,429 unique patients had a positive culture for an MDRO; 3,453 of these (78.0%) survived the index hospitalization. Moreover, 2,127 patients (61.6%) were readmitted ≥1 time within a year, for a total of 5,849 readmissions. Furthermore, 512 patients (24.1%) had the same or a different MDRO isolated from blood, BAL/bronchial wash, or another sterile site during a readmission. Bone marrow transplant, end-stage renal disease, lymphoma, methicillin-resistant Staphylococcus aureus, or carbapenem-resistant Pseudomonas aeruginosa during index hospitalization were factors associated with increased risk of having an MDRO isolated during a readmission. MDROs isolated during readmissions were in the same class of MDRO as the index hospitalization 9%–78% of the time, with variation by index pathogen.

CONCLUSIONS

Readmissions among patients with MDRO infections are frequent. Various patient and organism factors predispose to readmission. When readmitted patients had an MDRO, it was often a pathogen in the same class as that isolated during the index admission, with the exception of Acinetobacter (~9%).

Infect Control Hosp Epidemiol 2018;39:12–19

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 12 - 19
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Portions of this manuscript were presented in a preliminary form at the SHEA Spring 2017 conference on March 31, 2017, in St Louis, Missouri.

References

REFERENCES

1. Pearson, S, Stewart, S, Rubenach, S. Is health-related quality of life among older, chronically ill patients associated with unplanned readmission to hospital? Aust N Z J Med 1999;29:701–706.Google Scholar
2. Rodriguez-Artalejo, F, Guallar-Castillon, P, Pascual, CR, et al. Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Arch Intern Med 2005;165:1274–1279.Google Scholar
3. Hu, Y, McMurry, TL, Stukenborg, GJ, Kozower, BD. Readmission predicts 90-day mortality after esophagectomy: analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes. J Thorac Cardiovasc Surg 2015;150:1254–1260.CrossRefGoogle ScholarPubMed
4. Hicks, CW, Tosoian, JJ, Craig-Schapiro, R, et al. Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy. Am J Surg 2015;210:636–642.Google Scholar
5. Gohil, SK, Datta, R, Cao, C, et al. Impact of hospital population case-mix, including poverty, on hospital all-cause and infection-related 30-day readmission rates. Clin Infect Dis 2015;61:1235–1243.CrossRefGoogle ScholarPubMed
6. Prescott, HC, Langa, KM, Iwashyna, TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA 2015;313:1055–1057.CrossRefGoogle ScholarPubMed
7. Sun, A, Netzer, G, Small, DS, et al. Association between index hospitalization and hospital readmission in sepsis survivors. Crit Care Med 2016;44:478–487.Google Scholar
8. Prescott, HC, Langa, KM, Liu, V, Escobar, GJ, Iwashyna, TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med 2014;190:62–69.Google Scholar
9. Liu, V, Lei, X, Prescott, HC, Kipnis, P, Iwashyna, TJ, Escobar, GJ. Hospital readmission and healthcare utilization following sepsis in community settings. J Hosp Med 2014;9:502–507.CrossRefGoogle ScholarPubMed
10. Ortego, A, Gaieski, DF, Fuchs, BD, et al. Hospital-based acute care use in survivors of septic shock. Crit Care Med 2015;43:729–737.CrossRefGoogle ScholarPubMed
11. Wang, T, Derhovanessian, A, De Cruz, S, Belperio, JA, Deng, JC, Hoo, GS. Subsequent infections in survivors of sepsis: epidemiology and outcomes. J Intensive Care Med 2014;29:87–95.Google Scholar
12. Donnelly, JP, Hohmann, SF, Wang, HE. Unplanned readmissions after hospitalization for severe sepsis at academic medical center-affiliated hospitals. Crit Care Med 2015;43:1916–1927.CrossRefGoogle ScholarPubMed
13. Goodwin, AJ, Rice, DA, Simpson, KN, Ford, DW. Frequency, cost, and risk factors of readmissions among severe sepsis survivors. Crit Care Med 2015;43:738–746.Google Scholar
14. Jones, TK, Fuchs, BD, Small, DS, et al. Post-acute care use and hospital readmission after sepsis. Ann Am Thorac Soc 2015;12:904–913.CrossRefGoogle ScholarPubMed
15. Chang, DW, Tseng, CH, Shapiro, MF. Rehospitalizations following sepsis: common and costly. Crit Care Med 2015;43:2085–2093.Google Scholar
16. Mayr, FB, Talisa, VB, Balakumar, V, Chang, CH, Fine, M, Yende, S. Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions. JAMA 2017;317:530–531.Google Scholar
17. Nathwani, D, Raman, G, Sulham, K, Gavaghan, M, Menon, V. Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2014;3:32.CrossRefGoogle ScholarPubMed
18. Andruska, A, Micek, ST, Shindo, Y, et al. Pneumonia pathogen characterization Is an independent determinant of hospital readmission. Chest 2015;148:103–111.Google Scholar
19. Datta, R, Brown, S, Nguyen, VQ, et al. Quantifying the exposure to antibiotic-resistant pathogens among patients discharged from a single hospital across all California healthcare facilities. Infect Control Hosp Epidemiol 2015;36:1275–1282.CrossRefGoogle ScholarPubMed
20. Emerson, CB, Eyzaguirre, LM, Albrecht, JS, Comer, AC, Harris, AD, Furuno, JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012;33:539–544.Google Scholar
21. Micek, ST, Heard, KM, Gowan, M, Kollef, MH. Identifying critically ill patients at risk for inappropriate antibiotic therapy: a pilot study of a point-of-care decision support alert. Crit Care Med 2014;42:1832–1838.Google Scholar
22. Neuner, EA, Yeh, JY, Hall, GS, et al. Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Diagn Microbiol Infect Dis 2011;69:357–362.CrossRefGoogle ScholarPubMed
23. Quezada Joaquin, NM, Diekema, DJ, Perencevich, EN, Bailey, G, Winokur, PL, Schweizer, ML. Long-term risk for readmission, methicillin-resistant Staphylococcus aureus (MRSA) infection, and death among MRSA-colonized veterans. Antimicrob Agents Chemother 2013;57:1169–1172.CrossRefGoogle ScholarPubMed
24. Chopra, T, Neelakanta, A, Dombecki, C, et al. Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program. Am J Infect Control 2015;43:314–317.CrossRefGoogle ScholarPubMed
25. Duggal, A, Barsoum, W, Schmitt, SK. Patients with prosthetic joint infection on IV antibiotics are at high risk for readmission. Clin Orthop Relat Res 2009;467:1727–1731.Google Scholar
26. Unusual Susceptibility Profiles Alert. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/pdfs/gen-support/usp-alert-current.pdf. Accessed July 19, 2016.Google Scholar
27. Multidrug-Resistant Organism and Clostridium difficile Infection (MDRO/CDI) Module. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/ 12pscMDRO_CDA Dcurrent.pdf. Published 2016. Accessed July 19, 2016.Google Scholar
28. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.CrossRefGoogle ScholarPubMed
29. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. CLSI document M100-S25. Vol. 25. Wayne, PA: CLSI; 2015.Google Scholar
30. Messina, JA, Cober, E, Richter, SS, et al. Hospital readmissions in patients with Carbapenem-resistant Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2016;37:281–288.Google Scholar
31. Allison, GM, Muldoon, EG, Kent, DM, et al. Prediction model for 30-day hospital readmissions among patients discharged receiving outpatient parenteral antibiotic therapy. Clin Infect Dis 2014;58:812–819.Google Scholar
32. Yaw, LK, Robinson, JO, Ho, KM. A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis 2014;14:967–975.Google Scholar
33. Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida . Ann Intern Med 2002;136:834–844.Google Scholar
34. Butler, AM, Olsen, MA, Merz, LR, et al. Attributable costs of enterococcal bloodstream infections in a nonsurgical hospital cohort. Infect Control Hosp Epidemiol 2010;31:28–35.CrossRefGoogle Scholar
35. Palacios-Baena, ZR, Gutierrez-Gutierrez, B, De Cueto, M, et al. Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-beta-lactamase-producing Enterobacteriaceae. J Antimicrob Chemother 2017;72:906–913.Google Scholar
Supplementary material: Image

Burnham et al. supplementary material

Figure S1

Download Burnham et al. supplementary material(Image)
Image 614.7 KB
Supplementary material: File

Burnham et al. supplementary material

Tables S1-S6

Download Burnham et al. supplementary material(File)
File 65.3 KB