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Epidemiology of Methicillin-Resistant Staphylococcus aureus Pneumonia in Community Hospitals

Published online by Cambridge University Press:  10 May 2016

Sarah S. Lewis ,
Vanessa J. Walker ,
Mi Suk Lee ,
Luke Chen ,
Rebekah W. Moehring ,
Christopher E. Cox ,
Daniel J. Sexton  and
Deverick J. Anderson
Sarah S. Lewis*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina These authors contributed equally to this work
Vanessa J. Walker
Affiliation:
Division of Pulmonary Medicine and Critical Care, Department of Medicine, Duke University Medical Center, Durham, North Carolina These authors contributed equally to this work
Mi Suk Lee
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
Luke Chen
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Christopher E. Cox
Affiliation:
Division of Pulmonary Medicine and Critical Care, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
*
Duke University Medical Center 102359, Durham, NC 27710 (sarah.stamps@duke.edu).
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Abstract

Objective.

Describe the epidemiology of healthcare-related (ie, healthcare-associated and hospital-acquired) pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients in community hospitals.

Design.

Retrospective cohort study.

Setting.

Twenty-four community hospitals in the southeastern United States affiliated with the Duke Infection Control Outreach Network (median size, 211 beds; range, 103–658 beds).

Methods.

Adult patients with healthcare-related MRSA pneumonia admitted to study hospitals from January 1, 2008, to December 31, 2012, were identified using surveillance data. Seasonal and annual incidence rates (cases per 100,000 patient-days) were estimated using generalized estimating equation models. Characteristics of community-onset and hospital-onset cases were compared.

Results.

A total of 1,048 cases of healthcare-related pneumonia due to MRSA were observed during 5,863,941 patient-days. The annual incidence rate of healthcare-related MRSA pneumonia increased from 11.3 cases per 100,000 patient-days (95% confidence interval [CI], 6.8–18.7) in 2008 to 15.5 cases per 100,000 patient-days (95% CI, 8.4–28.5) in 2012 (P = .055). The incidence rate was highest in winter months and lowest in summer months (15.4 vs 11.1 cases per 100,000 patient-days; incidence rate ratio, 1.39 [95% CI, 1.06–1.82]; P = .016). A total of 814 cases (77.7%) were community-onset healthcare-associated pneumonia cases; only 49 cases (4.7%) were ventilator-associated cases. Of 811 patients whose disposition was known, 240 (29.6%) died during hospitalization or were discharged to hospice.

Conclusions.

From 2008 through 2012, the incidence of healthcare-related MRSA pneumonia among patients who were admitted to a large network of community hospitals increased, despite the decreasing incidence of invasive MRSA infections nationwide. Additional study is warranted to evaluate trends in this important and potentially modifiable public health problem.

Infect Control Hosp Epidemiol 2014;35(12):1452–1457

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 12 , December 2014 , pp. 1452 - 1457
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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