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Methicillin-Resistant Staphylococcus aureus Infections in California Hospital Patients, 1999 – 2006
Mary Tran, PhD, MPHNiya Fong, BS Microbiology
California Office of Statewide Health Planning and Development
October 2008
Slide 2APHA Annual Meeting
October 2008
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Mary Nelson Tran, PhD, MPH
“No relationships to disclose”
Slide 3APHA Annual Meeting
October 2008
Issues
• Steep increase in MRSA rates in US hospital and long-term care patients.– Healthcare-associated MRSA (HA-MRSA)
• Evidence that MRSA is also spreading into the community (schools, gymnasiums)– Community-acquired MRSA (CA-MRSA)
• Some evidence that patients with MRSA infections cost more to treat and have higher mortality rates compared with non-resistant S.aureus infections.
Slide 4APHA Annual Meeting
October 2008
Methods• Data source:
– Hospital Patient Discharge Data, 1999, 2001, 2003, 2005, 2006.• Definition of MRSA infection:
– S. aureus infection in any diagnosis field of the PDD record:• Three ICD-9 codes are specific for S. aureus:
– 038.11 = S. aureus septicemia– 482.41 = S. aureus pneumonia– 041.11 = S. aureus infection in conditions classified elsewhere or of unspecified
site
– Methicillin resistance: • ICD-9 code = V09.0 in any secondary diagnosis field (1-24)
– MRSA Rate:• % S. aureus infection cases that are resistant• =(MRSA / all S. aureus infections) * 100
• Statistical analyses by SAS, ver. 9.1• Maps by ArcView
Slide 5APHA Annual Meeting
October 2008
Comparison of National MRSA Rates* with California Rates**
*Klein, et al, Emerg Inf Dis, Dec. 2007:13(12)1840-46. **Authors’ analysis
0
10
20
30
40
50
60
70
1999 2001 2003 2005
% S
. au
reu
s ca
ses
are
MR
SA
Total MRSA rate: National
Total MRSA rate: California
Slide 6APHA Annual Meeting
October 2008
Volume of Hospitalizations with S. aureus Infection, by Resistance
Type. California, 1999-2006
30,772 28,289 28,986 27,611 27,547
13,50422,008
36,625
52,209 54,317
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
1999 2001 2003 2005 2006
Vo
lum
e o
f S
.au
reu
s an
d M
RS
A H
osp
ital
izat
ion
s
MRSA
non-MR SA
Slide 7APHA Annual Meeting
October 2008
Hospital MRSA Rates by Age Group. California, 1999-2006
0
10
20
30
40
50
60
70
80
1999 2001 2003 2005 2006
% S.aureus
are
MR
SA
0-1718-6465+All Hospitalizations
Slide 8APHA Annual Meeting
October 2008
Hospital MRSA Rates by Source of Admission. California, 1999-2006
0
10
20
30
40
50
60
70
80
90
1999 2001 2003 2005 2006
% S
.au
reu
s a
re M
RS
A
HomeSNFGACAll Hospitalizations
Slide 9APHA Annual Meeting
October 2008
Percent of S. aureus Infections Reported as MRSA for Hospital Patients, California
1999 and 2006
Slide 10APHA Annual Meeting
October 2008
Trends in Length of Stay per Hospitalization, by Infection Type. California, 1999-2006
0
5
10
15
20
25
1999 2001 2003 2005 2006
Ave
rag
e le
ng
th o
f st
ay (
Day
s)
SA not resistant
MRSA
no SA reported
Slide 11APHA Annual Meeting
October 2008
Trends in Percent of Cases Discharged to Skilled Nursing and to Home,
by Infection Type. California, 1999-2006
0
5
10
15
20
25
30
35
1999 2001 2003 2005 2006
% D
isch
arg
ed t
o s
kill
ed n
urs
ing
non-MR S.aureus
MRSA
No S.aureus
0
10
20
30
40
50
60
70
80
90
1999 2001 2003 2005 2006
% D
isch
arg
ed
to
ho
me
non-MR S.aureus
MRSA
No S.aureus
Slide 12APHA Annual Meeting
October 2008
Trends in the Percent Died In-Hospital, by Infection Type. California, 1999-2006
0
2
4
6
8
10
12
14
16
18
1999 2001 2003 2005 2006
% C
ases
die
d in
-ho
spit
al
non-MR S.aureus
MRSA
No S.aureus
Slide 13APHA Annual Meeting
October 2008
Trends in Total and Daily Charges per Hospitalization, by Infection Type.
California, 1999-2006
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$160,000
1999 2001 2003 2005 2006
Ave
rag
e to
tal
char
ge
for
ho
spit
aliz
atio
n
SA not resistant
MRSA
no SA reported
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
1999 2001 2003 2005 2006
Av
era
ge
ch
arg
e p
er
da
y o
f h
os
pit
ali
zati
on
SA not resistant
MRSA
no SA reported
Slide 14APHA Annual Meeting
October 2008
Limitations• This report is a conservative estimate of the volume and rate of
MRSA infection in California.– Only hospitalized cases are included. – Only S. aureus cases that were tested for antibiotic resistance and
reported as resistant could be counted as MRSA.
• Cases reported as “admissions from home” may include patients recently discharged from a hospital or long term care facility.
• These MRSA infections may or may not be cases of Healthcare Acquired Infections (HAI). The discharge records do not include sufficient information to identify which cases are HAI.
Slide 15APHA Annual Meeting
October 2008
Conclusions• California MRSA rate was lower than the overall US rate in 1999, but
surpassed it around 2003. – Hospital MRSA rate has risen in almost all counties
• Highest MRSA rates are found in patients who are: – Seniors and admissions from SNFs– But rates in other groups are catching up.
• For MRSA cases, in-hospital mortality and charges for care are declining.– Both trends may be related to MRSA patients’ shortened length of stay.
• MRSA rates for admissions from home are rising.– Does this indicate rising prevalence of Community-Acquired MRSA?
• Rates of MRSA discharges to home are rising.– Is there increased risk of spread of MRSA into the community?
Slide 16APHA Annual Meeting
October 2008
Acknowledgements
• Niya Fong: SAS analyses• Charlene Parham: Maps of MRSA rates
• MRSA electron micrograph. CDC/Janice Carr. http://www.cdc.gov/ncidod/dhqp/ar_MRSA_spotlight_2006.html.
Slide 17APHA Annual Meeting
October 2008
Questions
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