- In-hospital mortality associated. - with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus:. - Background: It remains unclear whether methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with higher mortality compared with non-MRSA pneumonia. - This study’s objective was to compare outcomes includ- ing in-hospital mortality and healthcare costs during hospitalisation between patients with MRSA pneumonia and those with non-MRSA pneumonia.. - In-hospital outcomes (mortality, length of stay and healthcare costs during hospitalisation) were compared between patients with and without MRSA infection.. - All-cause in-hospital mortality and healthcare costs during hospitalisation were compared for pneumonia patients with and without MRSA infection.. - Results: Of 450,317 inpatients with community-acquired pneumonia, 3102 patients with MRSA pneumonia were matched with 12,320 patients with non-MRSA pneumonia. - The MRSA pneumonia patients had higher mortality, longer hospital stays and higher costs. - Multivariable logistic regression analysis revealed that MRSA pneumonia was significantly associated with higher in-hospital mortality compared with non-MRSA pneumonia (adjusted odds ratio = 1.94. - Healthcare costs during hospitalisation were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia (difference = USD 8502. - Conclusions: MRSA infection was associated with higher in-hospital mortality and higher healthcare costs during hospitalisation, suggesting that preventing MRSA pneumonia is essential.. - Keywords: Methicillin-resistant Staphylococcus aureus pneumonia, Community-acquired pneumonia, In-hospital mortality, Healthcare costs during hospitalisation. - The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. - If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. - Methicillin-resistant Staphylococcus aureus (MRSA) is a drug-resistant bacterium. - 1 Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Full list of author information is available at the end of the article. - 51.3% and 53% of Staphylococcus aureus infections in the United States and Japan, respectively [1].. - how- ever, it remains unclear whether mortality from MRSA pneumonia is higher than mortality from non-MRSA pneumonia. - Only a few studies have compared mortality between MRSA pneumonia and non-MRSA pneumonia;. - one showed a trend toward higher in-hospital mortality among MRSA pneumonia patients [3], whereas another showed that MRSA infection did not affect intensive care unit (ICU) mortality or in-hospital mortality in patients with ventilator-associated pneumonia [4]. - These previ- ous studies did not adjust for pulmonary comorbidities, which have been reported to be associated with in-hospi- tal mortality in hospitalised patients with pneumonia [5].. - The aim of the present study was to use a national inpatient database to examine the differences in in-hos- pital mortality and healthcare costs during hospitalisa- tion between patients with MRSA pneumonia and those with non-MRSA pneumonia, adjusting for pulmonary comorbidities.. - The sensitivity and specificity of the recorded ICD-10 codes and procedures in the Diagnosis Procedure Combination database were validated in a pre- vious study [8].. - The Hugh-Jones classification is a widely used dysp- noea scale with the following categories: I (the patient’s breathing is as good as that of other people of own age and build while working, walking and climbing hills or stairs), II (the patient is able to walk at the pace of nor- mal people of the same age and build on level ground but. - The A-DROP score, established by the Japanese Res- piratory Society, is a modified version of the CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure-65) score [9]. - The Institutional Review Board of The University of Tokyo approved this study and waived the requirement for patient informed consent because of the anonymous nature of the data.. - We defined MRSA pneumonia patients as those who had both the ICD-10 code for MRSA pneumonia and records of the administration of anti-MRSA antibiot- ics (vancomycin, linezolid, teicoplanin or arbekacin) for more than 7 days.. - The secondary outcomes were 30-day in- hospital mortality, 90-day in-hospital mortality, length of stay and hospitalisation costs. - Among the patients with pneumonia, we selected an MRSA pneumonia group and a non-MRSA pneumonia group with 1:4 matching: for each patient in the MRSA. - pneumonia group, we identified four non-MRSA patients of the same sex who were admitted to the same hospital in the same year and whose ages were within 5 years of the age of the MRSA patient. - Then, using multivariable logistic regression analysis fitted with generalised estimating equations to account for the 1:4 matched-pair clustering, we examined the factors associated with all-cause in-hospital mortality.. - The following independent variables were included in the models: age, sex, MRSA pneumonia, BMI, Barthel Index, Hugh-Jones grade, A-DROP score, CRP ≥ 20 mg/mL or infiltration covering at least two- thirds of one lung on chest radiography, haemodialysis, mechanical ventilation at admission, ICU admission, arrival by ambulance, COPD, interstitial lung disease, aspiration pneumonia and Pseudomonas aeruginosa pneumonia. - For sensitivity analyses, we added inde- pendent variables of chronic heart failure, chronic liver disease, sepsis, acute renal failure, leukopenia, immuno- suppression and stroke to the multivariable regression models used in the main analyses. - Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.. - A total of 450,317 patients were hospitalised for com- munity-acquired pneumonia during the study period, including 3102 patients with MRSA pneumonia. - There were 44,854 in-hospital deaths (10.0. - The patients with MRSA pneumonia were matched with 12,320 patients hospitalised for non-MRSA pneumonia. - 10.8), and 66.4% of the patients were male. - Table 1 shows the characteristics of patients with MRSA pneumonia and non-MRSA pneumonia after 1:4 matching. - The MRSA pneumonia group tended to have lower BMIs, lower activities of daily living scores, higher Hugh-Jones grades, higher A-DROP scores, CRP ≥ 20 mg/mL or infiltration covering at least two-thirds of one lung on chest radiog- raphy, mechanical ventilation on the day of admission or the following day, ICU admission on the day of admission or the following day, ambulance use, aspiration pneumo- nia and end-stage renal disease with haemodialysis. - The percentages of patients with smoking history and COPD were lower in the MRSA pneumonia group than in the non-MRSA pneumonia group.. - All-cause in-hospital mortality was 31.2% in the MRSA pneumonia group, whereas it was 11.6% in the non- MRSA pneumonia group (Table 2). - All-cause 30-day and 90-day mortality were also higher in the MRSA pneumo- nia group than in the non-MRSA pneumonia group. - The duration of antibiotic therapy was longer in the MRSA pneumonia group than in the non-MRSA pneumonia group. - Length of hospital stay was longer and hospitali- sation costs were higher in the MRSA pneumonia group than in the non-MRSA pneumonia group.. - The percentage of patients with missing data on Hugh- Jones grade was 25.1% for all patients with pneumonia, and this number was higher for patients with MRSA pneumonia (37.5%) before multiple imputation. - Hospi- talisation costs data were missing for 0.2% of all patients with pneumonia.. - Table 3 shows the results of the multivariable logistic regression analysis with generalised estimating equa- tions after multiple imputation for all-cause in-hospital mortality. - MRSA pneumonia was significantly associated with higher mortality compared with non-MRSA pneu- monia (adjusted odds ratio = 1.94. - Table 1 Characteristics of patients with MRSA pneumonia and patients with non-MRSA pneumonia after 1:4 matching. - MRSA pneumonia Non-MRSA pneumonia p-value. - MRSA, methicillin-resistant Staphylococcus aureus. - Table 2 Outcomes of patients with MRSA pneumonia and patients with non-MRSA pneumonia after 1:4 matching. - In-hospital mortality lt. - Hospitalisation costs were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumo- nia (difference = United States Dollar (USD) 8502;. - In the sensitivity analyses, hospitalisation costs were significantly higher for patients with MRSA pneumo- nia than for those with non-MRSA pneumonia (dif- ference = USD 8457. - Using a nationwide inpatient database in Japan, our study showed that mortality was higher in patients with MRSA pneumonia than in those with non-MRSA pneumonia. - In addition, we showed that hospitalisation costs were higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia.. - In our study, in-hospital mortality among patients with MRSA pneumonia was 31.2%. - Previous stud- ies have reported MRSA pneumonia mortality to be around which is comparable to our results.. - Table 3 Multivariable logistic regression analysis with generalised estimating equations accounting for clustering within matched pairs for all-cause in-hospital mortality. - MRSA pneumonia lt. - Studies have shown conflicting results on the differ- ence in mortality between patients with MRSA pneumo- nia and those with non-MRSA pneumonia. - Some studies have shown higher mortality for patients with pneumo- nia caused by multidrug-resistant pathogens than for those with other types of pneumonia [2, 14], whereas other studies have found no significant differences [4, 16]. - Several studies have shown high mortality in patients with MRSA bacteraemia [17–19], but few studies have focused on MRSA pneumonia. - In the present study, we clearly demonstrated that mortality was twice as high in patients with MRSA pneumonia than in patients with non-MRSA pneumonia.. - We confirmed that healthcare costs were higher for MRSA pneumonia than for non-MRSA pneumonia, including methicillin-sensitive Staphylococ- cus aureus pneumonia. - Longer hospital stay may lead to higher hospitalisation costs in patients with MRSA pneu- monia. - Possible causes of the longer hospital stay are that patients with MRSA pneumonia are frailer and require longer duration of antibiotic therapy. - The patients with MRSA pneumonia tended to have lower BMIs and lower activities of daily living scores. - Although we adjusted for BMI and activities of daily living score, we were unable to fully evaluate frailty because the database lacked data on other components of the frailty definition, such as grip strength, exhaustion and slowness of walking [23].. - Previous studies have shown several pulmonary comor- bidities to be associated with higher mortality in patients with pneumonia, including interstitial lung disease [5, 24]. - The association between COPD and mortality remains uncertain in hospitalised adult patients with pneumonia [5, 26]. - Our multivariable regression analysis included these comorbidities, finding no significant association between COPD and in-hospital mortality.. - We therefore combined an MRSA diagnosis and treatment for MRSA to identify patients with MRSA pneumonia. - In conclusion, adjusted in-hospital mortality and hos- pitalisation costs were significantly higher for patients. - with MRSA pneumonia than for those with non-MRSA pneumonia in this matched-pair cohort study.. - MRSA: Methicillin-resistant Staphylococcus aureus. - Characteristics of patients with MRSA pneumonia and patients with non-MRSA pneumonia after 1:4 matching regarding with chronic heart failure, chronic liver diseases, sepsis, acute renal failure, leukopenia,immunosupression and stroke. - Sensitiv- ity analyses adjusted comorbidities including chronic heart failure, chroni- cliver diseases, sepsis, acute renal failure, leukopenia,immunosupression and stroke for all-cause in-hospital mortality.. - TJ had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. - YS contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. - HY contributed substantially to the data analysis and interpretation, and the writ- ing of the manuscript. - The funding bodies had no role in the design of the study. - the collection, analysis or interpretation of the data. - or the writing of the manuscript.. - Prevalence of and outcomes from Staphylococcus aureus pneumonia among hospitalized patients in the United States, 2009–2012. - The outcome of community-acquired pneumonia in patients with chronic lung disease: a case-control study. - Diagnosis and treatment of adults with community-acquired pneumonia. - An official clinical practice guideline of the American Tho- racic Society and Infectious Diseases Society of America. - Prediction of methicillin-resistant Staphylococcus aureus in patients with non-nosoco- mial pneumonia. - Predictive factors of methicillin-resistant Staphylococcus aureus infection in elderly patients with community-onset pneumonia. - Pre- dictors of mortality in Staphylococcus aureus bacteremia. - Methicillin-susceptible and methicillin-resistant Staphylococcus aureus bacteremia: nationwide estimates of 30-day readmission, in-hospital mortality, length of stay, and cost in the US. - Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta- analysis. - Costs of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus. - Clinical and economic outcomes in patients with community-acquired Staphylococ- cus aureus pneumonia. - National costs associated with methicillin-susceptible and methicillin- resistant Staphylococcus aureus hospitalizations in the United States, 2010–2014. - Respiratory comorbidities and risk of mortality in hospitalized patients with idi- opathic pulmonary fibrosis
Xem thử không khả dụng, vui lòng xem tại trang nguồn hoặc xem
Tóm tắt