IDweek 2014 SAB poster final2

726
Jean Lee, PharmD
Department of Pharmacy
Sinai Hospital of Baltimore
(410)245-2581
[email protected]
Readmissions associated with Staphylococcus aureus bacteremia
1
Pharm.D. ,
1,2
Pharm.D. ,
1
Pharm.D. ,
1
M.D.
Jean E. Lee,
Su Y. Lee,
Colby Miller,
John Cmar,
1
2
Sinai Hosp. of Baltimore, Baltimore, MD , Univ. Maryland Eastern Shore, Princess Anne, MD
Abstract
Methods
Introduction: Staphylococcus aureus bacteremia (SAB) is
one of the most common blood stream infections
resulting in significant mortality and morbidity. The
objective of the study was to evaluate outcomes in
patients with SAB.
Methods: We conducted a retrospective chart review of
the patients who were admitted to the hospital in 2013,
whose blood culture was positive of S. aureus.
Outcomes evaluated were mortality, follow up blood
cultures, length of stay (LOS), rate of readmission due
to another SAB, and all-cause 30-and 60-day
readmission rates. Statistical analyses were performed
with SPSS software and Microsoft Excel software, with
continuous and nominal data evaluated with the student
t test and the Fisher’s exact test, respectively.
Results: One hundred-three patients were identified to
have 115 inpatient encounters associated with
SAB. Mortality during index hospital stay was 17%.
Among the survivors, 26% didn’t have confirmatory
negative culture obtained prior to discharge. Length of
stay (LOS) was significantly shorter in patients who
didn’t have negative blood culture compared to patients
who had negative culture (5.2 days vs. 14.9 days,
P<0.0001). Eleven percent of patients had readmissions
with another SAB during the study period. All-cause 30and 60-day readmission rates were 26% and 40%,
respectively. In general, readmission rates were higher
in MRSA bacteremia patients compared to MSSA
bacteremia. Reviewing all-cause 60-day readmissions,
57% was due to an infection and 17 % was due to
conditions related to index SAB, such as allergic
reaction to antibiotic, acute kidney injury, intravascular
line issues, and/or opportunistic infections. Overall,
readmissions potentially associated with the index SAB
accounted for 74% of all-cause 60 day readmissions.
Conclusion: In patients who had index admission for
SAB, readmission rate with another SAB was 11%. Allcause readmission rates were 26% and 40%,
respectively in 30 days and 60 days. Seventy-four
percent of 60 days readmissions were potentially
related to the index SAB.
We conducted a retrospective chart review of the patients who were admitted to the hospital in 2013, whose blood culture was positive of S. aureus.
Outcomes evaluated were mortality, follow up blood cultures, length of stay (LOS), rate of readmission due to another SAB, and all-cause 30-and 60-day
readmission rates. Statistical analyses were performed with SPSS software and Microsoft Excel software, with continuous and nominal data evaluated with the
student t test and the Fisher’s exact test, respectively.
Introduction
Staphylococcus aureus (SA) bacteremia is one of
the most common blood stream infections
resulting in significant mortality and morbidity. The
objective of the study was to evaluate outcomes in
patients with SAB. Outcome data, including the
readmission rate, has been reviewed to assess
impact of SAB to hospital resource.
Results
SA
Table 1. Overview of SAB audit
SA, Survivors
SAB
# patients
# SA cases
Cases of MRSA
Patients expired / hospice
LOS, mean +/- Std dev
Cases discharged without negative blood culture
Days to negative blood culture, mean +/- Std dev
LOS from + blood draw, mean +/- Std dev
in cases without neg blood culture, mean +/- Std dev
in cases with neg blood culture, mean+/- Std dev
103
115
70
17
13.3
(61%)
(17%)
+/- 11.8
87
98
58
(59%)
13.4
25
6.2
12.4
5.2
14.9
+/- 10.9
(26%)
+/- 4.2
+/- 9.3
+/- 3.6
+/- 9.2
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MSSA
48
58
12.7
15
6.4
12.2
5.2
14.9
39
40
+/- 9.3
(26%)
+/- 3.6
+/- 9.2
+/- 4.0
+/- 9.0
14.4
9
5.9
12.7
5.4
14.8
+/- 12.9
(23%)
+/- 5.0
+/- 9.5
+/- 3.0
+/- 9.7
p=0.016
60%
50%
40%
30%
20%
10%
0%
SA
MRSA
MSSA
p=0.05
p=0.02
11%
52%
40%
35%
26%
19%
26%
15%
3%
SAB readmission in 2013
All-cause 30-day Readmission
All-cause 60-day Readmission
Figure 1. SAB readmissions and All-cause readmissions
Conclusion
Due to an
infection, 20 (57%)
60-day
Readmission
40%
No record of 60-day
readmit
60%
74% potentially
associated with
index SAB
Condition related
to index SAB, 6
(17%)
other, 9 (26%)
Figure 2. Reasons for 60-day readmissions in SAB
POSTER TEMPLATE BY:
MRSA
During 1-year cross-sectional period:
• Readmission rate with another SAB was 11%
– 19% vs. 3% for MRSA vs. MSSA, respectively
• Thirty-day readmission rate was 26%
– 35% vs. 15% for MRSA vs. MSSA
• Sixty-day readmission rate was 40%
– 52% vs. 26% for MRSA vs. MSSA
– Seventy four percent of 60-day readmission
were potentially associated with index SAB.

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