Major article
Surgical site infections: Causative pathogens and associated outcomes

https://doi.org/10.1016/j.ajic.2009.06.010Get rights and content

Background

Surgical site infections (SSIs) are associated with substantial morbidity, mortality, and cost. Few studies have examined the causative pathogens, mortality, and economic burden among patients rehospitalized for SSIs.

Methods

From 2003 to 2007, 8302 patients were readmitted to 97 US hospitals with a culture-confirmed SSI. We analyzed the causative pathogens and their associations with in-hospital mortality, length of stay (LOS), and cost.

Results

The proportion of methicillin-resistant Staphylococcus aureus (MRSA) significantly increased among culture-positive SSI patients during the study period (16.1% to 20.6%, respectively, P < .0001). MRSA (compared with other) infections had higher raw mortality rates (1.4% vs 0.8%, respectively, P = .03), longer LOS (median, 6 vs 5 days, respectively, P < .0001), and higher hospital costs ($7036 vs $6134, respectively, P < .0001). The MRSA infection risk-adjusted attributable LOS increase was 0.93 days (95% confidence interval [CI]: 0.65-1.21; P < .0001), and cost increase was $1157 (95% CI: $641-$1644; P < .0001). Other significant independent risk factors increasing cost and LOS included illness severity, transfer from another health care facility, previous admission (<30 days), and other polymicrobial infections (P < .05).

Conclusion

SSIs caused by MRSA increased significantly and were independently associated with economic burden. Admission illness severity, transfer from another health care setting, and recent hospitalization were associated with higher mortality, increased LOS, and cost.

Section snippets

Data source

We obtained the data for this study from clinical information collected in the Cardinal Health Outcomes Research Database (Cardinal Health Clinical Research Services, Marlborough, MA). This database has been used for research since the late 1980s, and the system has been fully described elsewhere.9, 10, 11 Briefly, it captures clinical information from patients admitted to participating acute care hospitals. In addition to clinical findings, the database contains chemistry and hematology

Patient population

In the population analyzed, 8302 patients met the selection criteria. The median age for the study population was 58 (interquartile range, 46-71) years, and 45.6% were male (see Table 1). Among the eligible patients, 47.3% had a previous admission at the same hospital within the prior 30 days, 4.6% were transferred from another acute care hospital, and 3.3% came from a skilled nursing facility. Three quarters of patients had at least 1 important physiologic derangement. The most frequently

Discussion

The results of this study provide an overview of the current epidemiology, microbiology, clinical outcomes, and economic costs of SSI in a large cohort of northeastern US hospitals. These 8302 patients in our study were demographically similar to those described in other studies of SSI.14

The only pathogen showing a significant change in isolation rate during the study period was MRSA, which rose from 16.1% to 20.6% among all those with culture-confirmed SSIs. These findings are compatible with

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    Conflicts of interest: Dr. Weigelt is an advisory board member, on the speaker's bureau, received research support from OMJUS; Dr. Lipsky is an advisory board member and has received research support from OMJUS; Dr. Kim is a current employee of OMJUS; Ms. Derby and Drs. Tabak and Gupta are currently employees of Cardinal Health, Inc. Dr. Lipsky is an employee of the US Government. This paper does not represent the views of the US Government.

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