en
Scientific article
English

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

Published inThe Journal of hospital infection, vol. 78, no. 2, p. 86-91
Publication date2011
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 use
  • Carrier State/drug therapy/economics/epidemiology/microbiology
  • Cross Infection/drug therapy/economics/epidemiology/microbiology
  • Humans
  • Length of Stay/economics/statistics & numerical data
  • Methicillin-Resistant Staphylococcus aureus/drug effects/isolation & purification
  • Models, Biological
  • Patient Discharge/statistics & numerical data
  • Proportional Hazards Models
  • Staphylococcal Infections/drug therapy/economics/epidemiology/microbiology
  • Surgical Wound Infection/drug therapy/economics/epidemiology/microbiology
  • Time Factors
Citation (ISO format)
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: The Journal of hospital infection, 2011, vol. 78, n° 2, p. 86–91. doi: 10.1016/j.jhin.2011.02.003
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Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal0195-6701
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