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Surgical-Site Infection Due to Staphylococcus aureus Among Elderly Patients Mortality, Duration of Hospitalization, and Cost

Published online by Cambridge University Press:  02 January 2015

Sarah A. McGarry ,
John J. Engemann ,
Kenneth Schmader ,
Daniel J. Sexton  and
Keith S. Kaye
Sarah A. McGarry
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
John J. Engemann
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Kenneth Schmader
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina Center for the Study of Aging and Human Development, Duke University Medical Center, and the General Research Education & Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Keith S. Kaye*
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
*
Box 3152, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710
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Abstract

Objectives:

To examine the impact of surgical-site infection (SSI) due to Staphylococcus aureus on mortality, duration of hospitalization, and hospital charges among elderly surgical patients and the impact of older age on these outcomes by comparing older and younger patients with S. aureus SSI.

Design:

A nested cohort study.

Setting:

A 750-bed, tertiary-care hospital and a 350-bed community hospital.

Patients:

Ninety-six elderly patients (70 years and older) with S. aureus SSI were compared with 2 reference groups: 59 uninfected elderly patients and 131 younger patients with S. aureus SSI.

Results:

Compared with uninfected elderly patients, elderly patients with S. aureus SSI were at risk for increased mortality (odds ratio [OR], 5.4; 95% confidence interval [CI95], 1.5-20.1), postoperative hospital-days (2.5-fold increase; CI95, 2.0-3.1), and hospital charges (2.0-fold increase; CI95, 1.7-2.4; $41,117 mean attributable charges per SSI). Compared with younger patients with S. aureus SSI, elderly patients had increased mortality (adjusted OR, 2.9; CI95, 1.1-7.6), hospital-days (9 vs 13 days; P = .001), and median hospital charges ($45,767 vs $85,648; P < .001).

Conclusions:

Among elderly surgical patients, S. aureus SSI was independently associated with increased mortality, hospital-days, and cost. In addition, being at least 70 years old was a predictor of death in patients with S. aureus SSI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 461 - 467
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Crossley, K, Peterson, PK. Infections in the elderly: new developments. Curr Clin Top Infect Dis 1998;18:75–100.Google ScholarPubMed
2.Emori, TG, Banerjee, SN, Culver, DH, et al.Nosocomial infections in elderly patients in the United States, 1986-1990. Am J Med 1991;1:289S–293S.CrossRefGoogle Scholar
3.Petti, CA, Sanders, LL, Trivette, SL, et al.Postoperative bacteremia secondary to surgical site infection. Clin Infect Dis 2002;34:305–308.CrossRefGoogle ScholarPubMed
4.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from October 1986-April 1996, issued May 1996. Am J Infect Control 1996;24:380–388.CrossRefGoogle Scholar
5.Martone, WJ, Jarvis, WR, Edwards, JR, et al.Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett, J, Brachman, PS, eds. Hospital Infections, ed. 4. Philadelphia: Lippincott-Raven; 1998.Google Scholar
6.Nicolle, LE, Huchcroft, SA, Cruse, PJ. Risk factors for surgical wound infection among the elderly. J Clin Epidemiol 1992;45:357–364.CrossRefGoogle ScholarPubMed
7.Kaye, KS, Gold, HS, Schwaber, MJ, et al.Variety of beta-lactamases produced by amoxicillin-clavulanate-resistant Escherichia coli isolated in the northeastern United States. Antimicrob Agents Chemother 2004;48:1520–1525.CrossRefGoogle ScholarPubMed
8.Engemann, J, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.CrossRefGoogle ScholarPubMed
9.Garner, JS, Jarvis, WR, Emori, TG, et al.CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
10.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: Twelfth Informational Supplement. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002:22. M100–S12.Google Scholar
11.Culver, DH, Horan, TC, Gaynes, RP, et al.Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91:152S–157S.CrossRefGoogle ScholarPubMed
12.Owens, WD, Felts, JA, Spitznagel, EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–243.CrossRefGoogle ScholarPubMed
13.Poses, RM, McClish, DK, Smith, WR, et al.Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol 1996;49:743–747.CrossRefGoogle ScholarPubMed
14.MyFamily.com, Inc. Social Security Death Index. Provo, UT: MyFamily.com, Inc.; 1998. Available at www.ancestry.com. Accessed November 10, 2003.Google Scholar
15.Kirkland, KB, Briggs, JP, Trivette, SL, et al.The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.CrossRefGoogle ScholarPubMed
16.McClelland, RS, Fowler, VG Jr, Sanders, LL, et al.Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality. Arch Intern Med 1999;159:1244–1247.CrossRefGoogle ScholarPubMed
17.Raymond, DP, Pelletier, SJ, Crabtree, TD, et al.Surgical infection and the aging population. Am Surg 2001;67:827–833.CrossRefGoogle ScholarPubMed