Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients > 13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p < 0.01), yielding an excess hospital stay among cases of 32.1 days. the excess mortality among cases compared to controls that was attributable to s. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p < 0.01). the cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. healthcare-associated s. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential.

Enterococo resistente à vancomicina em um Hospital Universitário no Centro-oeste do Brasil / Vancomycin-resistant enterococcus in an university hospital in center-west of Brazil

O enterococo resistente à vancomicina (VRE) atualmente constitui uma preocupação para os profissionais da área da saúde em razão de sua crescente incidência nos serviços de assistência à saúde. No presente estudo, descreve-se o primeiro caso de VRE identificado na cidade de Goiânia,Região Centro-Oeste do Brasil, isolado de paciente masculino, 70 anos, admitido no hospital com diagnóstico de aneurisma de aorta abdominal infrarrenal. Diversos procedimentos cirúrgicos foram realizados com o uso de múltiplos antimicrobianos, mas após 61 dias a doença levou o paciente aóbito. Dentre as possíveis causas da morte, aponta-se a sepse indicada pela cultura de secreção de ferida operatória com isolamento e identificação de VRE.

Bacteremias em pacientes internados em hospital universitário / Bacteremias at a teaching hospital: etiology, antimicrobial susceptibiliy pattern and risk factors for mortality

OBJETIVO: Avaliar a incidência de bacteremias, seu perfil de suscetibilidade antimicrobiana, e fatores associados ao óbito, em hospital universitário, no período de 1° de janeiro de 2000 a 31 de dezembro de 2001. MÉTODOS: Coorte retrospectiva. Pacientes maiores de 1 ano de idade, com bacteremia laboratorialmente confirmada e clinicamente significativa foram incluídos no estudo. Realizada análise de sobrevida multivariada, seguindo o modelo de riscos proporcionais de Cox. RESULTADOS: Foram detectados 295 episódios de bacteremia. O patógeno mais freqüente foi o Staphylococcus aureus: 118 (40 por cento), com 55,9 por cento de MRSA. A letalidade pela bacteremia foi de 34,5 por cento. Os fatores de risco independentes para o óbito foram terapia inicial inadequada (HR ajustado 2,05 IC 95 por cento: 1,25-3,36) e gravidade da apresentação clínica (HR ajustado 5,52 IC 95 por cento: 3,15-9,69). CONCLUSÃO: Nosso estudo mostrou elevada letalidade associada a bacteremia, com alta freqüência de MRSA. A terapia inicial inadequada e a gravidade da apresentação clínica foram fatores de risco independentes para o óbito pela bacteremia.

OBJECTIVE: To evaluate the frequency and profile of bacteremia, its antimicrobial susceptibility and to analyze predictors of mortality in bloodstream infections (BSI) at this Teaching Hospital from January 1, 2000 to December 31, 2001. METHODS: Design: retrospective cohort. Patients over one year old with clinically significant episodes of BSI which were microbiologically documented were included in the study. The Cox proportional hazards risk model was applied to identify prognostic factors related to death by bacteremia. RESULTS: A total of 295 episodes of BSI were detected. The most common pathogen was S. aureus: 118 (40.0 percent), with 55.9 percent of MRSA. Mortality associated with bacteremia was 34.5 percent. Independent predictors of mortality were: inadequate initial therapy (HR adjusted 2.05 IC95 percent: 1.25-3.36) and severity of the clinical manifestations (HR adjusted 5.52 IC95 percent: 3.15-9.69). CONCLUSION: This study disclosed high mortality rates due to BSI and a high frequency of MRSA. Inadequate initial therapy and severity of clinical manifestations were significantly and independently associated with mortality.