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Multistate modelling to estimate the excess length of stay associated with meticillin-resistant Staphylococcus aureus colonisation and infection in surgical patients

De Angelis, G
Allignol, A
Murthy, A
Wolkewitz, M
Beyersmann, J
Safran, E
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Published in Journal of Hospital Infection. 2011, vol. 78, no. 2, p. 86-91
Abstract Currently available evidence on the excess length of stay (LOS) associated with nosocomial infections is limited by methodology, including time-dependent bias. To determine the excess LOS associated with nosocomial meticillin-resistant Staphylococcus aureus (MRSA) infection and colonisation, 797 MRSA-colonised, 167 MRSA-infected and 13,640 MRSA-negative surgical patients were included in a multistate model. The occurrence of MRSA infection or colonisation was the time-dependent exposure, and discharge or death was the study endpoint. The excess LOS was extracted by computing the Aalen-Johansen estimator of the matrix of transition probabilities. Multivariate Cox regression analysis was used to assess the independent effect of MRSA on excess LOS. MRSA infection prolonged LOS by 14.5 [95% confidence interval (CI): 7.8, 21.3] days compared to uninfected patients, and by 5.9 (95% CI: 0.1, 11.7) days compared to patients only colonised by MRSA. The hazard of discharge was reduced by nosocomial MRSA infection both with respect to MRSA-free patients and MRSA carriers [adjusted hazard ratio (HR): 0.69; 95% CI: 0.59, 0.81; and HR: 0.79; 95% CI: 0.65, 0.95, respectively]. MRSA carriage alone did not decrease the hazard of discharge after adjustment for confounding (HR: 1.00; 95% CI: 0.93, 1.07). Multistate modelling is a promising statistical method to evaluate the health-economic impact of nosocomial antibiotic-resistant infections.
Keywords Anti-Bacterial Agents/pharmacology/therapeutic useCarrier State/drug therapy/economics/epidemiology/microbiologyCross Infection/drug therapy/economics/epidemiology/microbiologyHumansLength of Stay/economics/statistics & numerical dataMethicillin-Resistant Staphylococcus aureus/drug effects/isolation & purificationModels, BiologicalPatient Discharge/statistics & numerical dataProportional Hazards ModelsStaphylococcal Infections/drug therapy/economics/epidemiology/microbiologySurgical Wound Infection/drug therapy/economics/epidemiology/microbiologyTime Factors
PMID: 21481492
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Research groups Analyse génomique et fonctionnelle du staphylocoque doré (604)
Groupe Harbarth Stephan (Staphylocoques dorés résistants à la méthicilline) (866)
Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
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DE ANGELIS, G et al. Multistate modelling to estimate the excess length of stay associated with meticillin-resistant Staphylococcus aureus colonisation and infection in surgical patients. In: Journal of Hospital Infection, 2011, vol. 78, n° 2, p. 86-91. https://archive-ouverte.unige.ch/unige:25450

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Deposited on : 2013-01-14

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