Increased prevalence of and associated mortality with methicillin-resistant staphylococcus aureus among hospitalized IBD patients

Geoffrey C. Nguyen, Harshna Patel, Rachel Y. Chong

Research output: Contribution to journalArticle

Abstract

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly prevalent in US hospitals, and the impact of MRSA on hospitalized inflammatory bowel disease (IBD) patients is unknown. Methods: We used the Nationwide Inpatient Sample to identify admissions for IBD (n116,842) between 1998 and 2004. We compared prevalence and in-hospital mortality of MRSA among IBD, non-IBD gastrointestinal (GI), and general medical inpatients. Results: MRSA prevalence increased from 4.5/10,000 to 19.0/10,000 over the 7-year period (P0.0001). After adjustment for confounders, IBD inpatients were at increased risk of MRSA compared with the non-IBD GI (adjusted odds ratio (aOR) 1.61; 95% confidence interval (CI): 1.33-1.96) and general medical (aOR 1.36; 95% CI: 1.11-1.66) groups. Of those with MRSA, catheter-related infections were specifically more common among IBD compared with non-IBD GI and general inpatients (28.8% vs. 11.0% and 8.5%, respectively, P0.0002). Bowel surgery, parenteral nutrition, and health insurance were predictors of MRSA infection, but the first two became insignificant after controlling for length of stay (LOS). Compared with LOS 7days, MRSA was more likely among those hospitalized 8-21 days (aOR 7.40; 95% CI: 4.68-11.7) and 21 days (aOR 58.6; 95% CI: 36.0-95.3). MRSA infection was associated with sevenfold increase in mortality (aOR 7.61; 95% CI: 3.33-17.4). Conclusions: Hospitalized IBD patients are at increased risk of MRSA compared with non-IBD GI and general medical inpatients. Increased mortality in the IBD population associated with MRSA reinforces the importance of measures to prevent nosocomial infection and to reduce length of hospitalization.

Original languageEnglish (US)
Pages (from-to)371-377
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume105
Issue number2
DOIs
StatePublished - Feb 2010

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Methicillin-Resistant Staphylococcus aureus
Inflammatory Bowel Diseases
Mortality
Gastrointestinal Diseases
Inpatients
Odds Ratio
Confidence Intervals
Length of Stay
Infection
Catheter-Related Infections
Parenteral Nutrition
Health Insurance
Cross Infection
Hospital Mortality
Hospitalization

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Increased prevalence of and associated mortality with methicillin-resistant staphylococcus aureus among hospitalized IBD patients. / Nguyen, Geoffrey C.; Patel, Harshna; Chong, Rachel Y.

In: American Journal of Gastroenterology, Vol. 105, No. 2, 02.2010, p. 371-377.

Research output: Contribution to journalArticle

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abstract = "Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly prevalent in US hospitals, and the impact of MRSA on hospitalized inflammatory bowel disease (IBD) patients is unknown. Methods: We used the Nationwide Inpatient Sample to identify admissions for IBD (n116,842) between 1998 and 2004. We compared prevalence and in-hospital mortality of MRSA among IBD, non-IBD gastrointestinal (GI), and general medical inpatients. Results: MRSA prevalence increased from 4.5/10,000 to 19.0/10,000 over the 7-year period (P0.0001). After adjustment for confounders, IBD inpatients were at increased risk of MRSA compared with the non-IBD GI (adjusted odds ratio (aOR) 1.61; 95{\%} confidence interval (CI): 1.33-1.96) and general medical (aOR 1.36; 95{\%} CI: 1.11-1.66) groups. Of those with MRSA, catheter-related infections were specifically more common among IBD compared with non-IBD GI and general inpatients (28.8{\%} vs. 11.0{\%} and 8.5{\%}, respectively, P0.0002). Bowel surgery, parenteral nutrition, and health insurance were predictors of MRSA infection, but the first two became insignificant after controlling for length of stay (LOS). Compared with LOS 7days, MRSA was more likely among those hospitalized 8-21 days (aOR 7.40; 95{\%} CI: 4.68-11.7) and 21 days (aOR 58.6; 95{\%} CI: 36.0-95.3). MRSA infection was associated with sevenfold increase in mortality (aOR 7.61; 95{\%} CI: 3.33-17.4). Conclusions: Hospitalized IBD patients are at increased risk of MRSA compared with non-IBD GI and general medical inpatients. Increased mortality in the IBD population associated with MRSA reinforces the importance of measures to prevent nosocomial infection and to reduce length of hospitalization.",
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