Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005

Eili Klein, David L Smith, Ramanan Laxminarayan, Eili Klein, David L Smith, Ramanan Laxminarayan

Abstract

Hospital-acquired infections with Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA) infections, are a major cause of illness and death and impose serious economic costs on patients and hospitals. However, the recent magnitude and trend of these infections have not been reported. We used national hospitalization and resistance data to estimate the annual number of hospitalizations and deaths associated with S. aureus and MRSA from 1999 through 2005. During this period, the estimated number of S. aureus-related hospitalizations increased 62%, from 294,570 to 477,927, and the estimated number of MRSA-related hospitalizations more than doubled, from 127,036 to 278,203. Our findings suggest that S. aureus and MRSA should be considered a national priority for disease control.

Figures

Figure 1
Figure 1
Estimated methicillin-resistant Staphylococcus aureus (MRSA)–related hospitalization rates, United States, 1999–2005. Rates are no. MRSA-related discharges/1,000 hospitalizations. Error bars represent 95% confidence intervals.
Figure 2
Figure 2
Primary diagnoses of Staphylococcus aureus–related hospitalizations. The most frequent primary diagnosis associated with other S. aureus–related infections was other cellulitis and abscess (International Classification of Diseases [ICD]-9 682), followed by postoperative infection (ICD-9 998.59), infections from an implanted device or graft (ICD-9 996), osteomyelitis (ICD-9 730), and diabetes mellitus (ICD-9 250). Cellulitis and abscess infections increased at a rate >25% per year from 1999 through 2005. No other primary diagnosis infection showed a major increase over this period.
Figure 3
Figure 3
Estimated hospital deaths associated with Staphylococcus aureus and methicillin-resistant S. aureus (MRSA), United States, 1999–2005. Error bars represent 95% confidence intervals.
Figure 4
Figure 4
Percentage of Staphylococcus aureus isolates resistant to methicillin in national surveys, United States, 1999–2004. TSN, The Surveillance Network (data include hospital infections); NNIS, National Nosocomial Infections Surveillance System (data include only intensive care units); SENTRY, includes only skin and soft tissue infections.

References

    1. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. Crit Care Med. 1999;27:887–92. 10.1097/00003246-199905000-00020
    1. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. Pediatrics. 1999;103:e39. 10.1542/peds.103.4.e39
    1. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17. 10.1086/421946
    1. Lowy FD. Antimicrobial resistance: the example of Staphylococcus aureus. J Clin Invest. 2003;111:1265–73.
    1. Chambers HF. The changing epidemiology of Staphylococcus aureus. Emerg Infect Dis. 2001;7:178–82. 10.3201/eid0702.010204
    1. Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol. 1996;17:129–40. 10.1086/647257
    1. Crum NF, Lee RU, Thornton SA, Stine OC, Wallace MR, Barrozo C, et al. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med. 2006;119:943–51. 10.1016/j.amjmed.2006.01.004
    1. Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998;339:520–32. 10.1056/NEJM199808203390806
    1. Carleton HA, Diep BA, Charlebois ED, Sensabaugh GF, Perdreau-Remington F. Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): population dynamics of an expanding community reservoir of MRSA. J Infect Dis. 2004;190:1730–8. 10.1086/425019
    1. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470–85. 10.1016/j.ajic.2004.10.001
    1. Klevens RM, Edwards JR, Tenover FC, McDonald LC, Horan T, Gaynes R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992–2003. Clin Infect Dis. 2006;42:389–91. 10.1086/499367
    1. King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144:309–17.
    1. Kuehnert MJ, Hill HA, Kupronis BA, Tokars JI, Solomon SL, Jernigan DB. Methicillin-resistant Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis. 2005;11:868–72.
    1. Noskin GA, Rubin RJ, Schentag JJ, Kluytmans J, Hedblom EC, Smulders M, et al. The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 nationwide inpatient sample database. Arch Intern Med. 2005;165:1756–61. 10.1001/archinte.165.15.1756
    1. Sahm DF, Marsilio MK, Piazza G. Antimicrobial resistance in key bloodstream bacterial isolates: electronic surveillance with the surveillance network database—USA. Clin Infect Dis. 1999;29:259–63. 10.1086/520195
    1. Dennison C, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 1. 2000; (39):1–42.
    1. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857–72. 10.1002/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>;2-E
    1. Barnett HA. The variance of the product of two independent variables and its application to an investigation based on sample data. J Inst Actuar. 1955;81:190.
    1. Goodman LA. On the exact variance of products. J Am Stat Assoc. 1960;55:708–13. 10.2307/2281592
    1. Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–74. 10.1056/NEJMoa055356
    1. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee. HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control. 2002;30:S1–46. 10.1067/mic.2002.130391
    1. Warshawsky B, Hussain Z, Gregson DB, Alder R, Austin M, Bruckschwaiger D, et al. Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol. 2000;21:724–7. 10.1086/501718
    1. Jones ME, Mayfield DC, Thornsberry C, Karlowsky JA, Sahm DF, Peterson D. Prevalence of oxacillin resistance in Staphylococcus aureus among inpatients and outpatients in the United States during 2000. Antimicrob Agents Chemother. 2002;46:3104–5. 10.1128/AAC.46.9.3104-3105.2002
    1. Salgado CD, Farr BM, Calfee DP. Community-acquired methicillin-resistant Staphylococcus aureus: A meta-analysis of prevalence and risk factors. Clin Infect Dis. 2003;36:131–9. 10.1086/345436
    1. Maree CL, Daum R, Boyle-Vavra S, Matayoshi K, Miller L. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis. 2007;13:236–42. 10.3201/eid1302.060781
    1. Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005;352:1436–44. 10.1056/NEJMoa043252
    1. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998;279:593–8. 10.1001/jama.279.8.593
    1. Ossowski K, Chun RH, Suskind D, Baroody FM. Increased isolation of methicillin-resistant Staphylococcus aureus in pediatric head and neck abscesses. Arch Otolaryngol Head Neck Surg. 2006;132:1176–81. 10.1001/archotol.132.11.1176
    1. Martone WJ, Jarvis WR, Edwards JR, Culver D, Haley RW. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett JV, Brachman PS, editors. Hospital infections, 4th ed. Philadelphia: Lippincott Williams and Wilkins; 1998. p. 461–76.
    1. Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003;36:1433–7. 10.1086/375081
    1. Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol. 2005;26:166–74. 10.1086/502522
    1. McHugh CG, Riley LW. Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections. Infect Control Hosp Epidemiol. 2004;25:425–30. 10.1086/502417
    1. Rubin RJ, Harrington CA, Poon A, Dietrich K, Greene JA, Moiduddin A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis. 1999;5:9–17. 10.3201/eid0501.990102
    1. Freidlin J, Acharya N, Lietman TM, Cevallos V, Whitcher JP, Margolis TP. Spectrum of eye disease caused by methicillin-resistant Staphylococcus aureus. Am J Ophthalmol. 2007;144:313–5. 10.1016/j.ajo.2007.03.032
    1. Sieradzki K, Roberts RB, Haber SW, Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med. 1999;340:517–23. 10.1056/NEJM199902183400704
    1. Johnson JK, Khoie T, Shurland S, Kreisel K, Stine OC, Roghmann MC. Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus USA300 clone. Emerg Infect Dis. 2007;13:1195–200.
    1. McCaig LF, McDonald LC, Mandal S, Jernigan DB. Staphylococcus aureus–associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis. 2006;12:1715–23.
    1. Ollendorf DA, Fendrick AM, Massey K, Williams GR, Oster G. Is sepsis accurately coded on hospital bills? Value Health. 2002;5:79–81. 10.1046/j.1524-4733.2002.52013.x
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54. 10.1056/NEJMoa022139
    1. Lucet J-C, Chevret S, Durand-Zaleski I, Chastang C, Regnier B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med. 2003;163:181–8. 10.1001/archinte.163.2.181

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