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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 (burnham@wustl.edu) 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 (kollefm@wustl.edu).
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 (burnham@wustl.edu) 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 (kollefm@wustl.edu).
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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 

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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.

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