Author:
Sakamoto Yukiyo,Yamauchi Yasuhiro,Jo Taisuke,Michihata Nobuaki,Hasegawa Wakae,Takeshima Hideyuki,Matsui Hiroki,Fushimi Kiyohide,Yasunaga Hideo,Nagase Takahide
Abstract
Abstract
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 including in-hospital mortality and healthcare costs during hospitalisation between patients with MRSA pneumonia and those with non-MRSA pneumonia.
Methods
Using a national inpatient database in Japan, we conducted a 1:4 matched-pair cohort study of inpatients with community-acquired pneumonia from 1 April 2012 to 31 March 2014. In-hospital outcomes (mortality, length of stay and healthcare costs during hospitalisation) were compared between patients with and without MRSA infection. We performed multiple imputation using chained equations followed by multivariable regression analyses fitted with generalised estimating equations to account for clustering within matched pairs. 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; 95% confidence interval: 1.72–2.18; p < 0.001). Healthcare costs during hospitalisation were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia (difference = USD 8502; 95% confidence interval: USD 7959–9045; p < 0.001).
Conclusions
MRSA infection was associated with higher in-hospital mortality and higher healthcare costs during hospitalisation, suggesting that preventing MRSA pneumonia is essential.
Funder
The Ministry of Health, Labour and Welfare, Japan
The Ministry of Education, Culture, Sports, Science and Technology, Japan
Publisher
Springer Science and Business Media LLC
Subject
Pulmonary and Respiratory Medicine
Reference26 articles.
1. World Health Organization. Antimicrobial Resistance: Global Report on Surveillance. 2014. https://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1. Accessed 7 Feb 2020.
2. Falcone M, Russo A, Giannella M, Cangemi R, Scarpellini MG, Bertazzoni G, et al. Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia. PLoS ONE. 2015;10:e0119528.
3. Jacobs DM, Shaver A. Prevalence of and outcomes from Staphylococcus aureus pneumonia among hospitalized patients in the United States, 2009–2012. Am J Infect Control. 2017;45:404–9.
4. Zahar JR, Clec’h C, Tafflet M, Garrouste-Orgeas M, Jamali S, Mourvillier B, et al. Is methicillin resistance associated with a worse prognosis in Staphylococcus aureus ventilator-associated pneumonia? Clin Infect Dis 2005; 41: 1224–1231.
5. Dusemund F, Chronis J, Baty F, Albrich WC, Brutsche MH. The outcome of community-acquired pneumonia in patients with chronic lung disease: a case-control study. Swiss Med Wkly. 2014;144:w1401.
Cited by
7 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献