[Staphylococcus aureus infection in an acute geriatric unit]. / Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos.

OBJECTIVE: The aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU). MATERIAL AND METHODS: We retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record. RESULTS: Data were obtained from 47 patients with MRSA (mean age 86.15+/-5.5 years) and from 4281 patients without MRSA (mean age 85.25+/-6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43+/-33.05 vs. 55.24+/-34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15+/-13.67 vs. 10.64+/-7.69 days, p<0.001) and higher hospital cost per patient (7517.71+/-4639.59 vs 3611.21+/-2609.98 euro, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95-7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22-5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60-12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32-13.75). CONCLUSION: MRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs.

Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos / Staphylococcus aureus infection in an acute geriatric unit

Objetivo Conocer el riesgo de muerte, el deterioro funcional, la institucionalización y el coste hospitalario asociado a la infección por Staphylococcus aureus meticilina resistente (SAMR) en una unidad geriátrica de agudos (UGA). Material y métodos Recogida retrospectiva de datos de pacientes ingresados en una UGA durante 5 años (del 1-1-2001 al 1-1-2006). Se compara la mortalidad, la institucionalización y la pérdida funcional al alta, la estancia y los costes hospitalarios en pacientes con SAMR y en el resto de los pacientes sin SAMR. La infección por SAMR fue documentada por el Servicio de Microbiología por cultivo y antibiograma, junto con el diagnóstico clínico de infección hospitalaria recogida en la historia clínica. Resultados La muestra de estudio fue de 47 pacientes con SAMR (edad media de 86,15±5,5 años) y 4.281 pacientes sin SAMR (edad media de 85,25±6 años). Los pacientes con SAMR presentaron mayor mortalidad (25,5 vs. 7,7%; p<0,001); peor situación funcional al alta (índice de Barthel: 39,43±33,05 vs. 55,24±34,99; p<0,01) y mayor institucionalización (29 vs. 9%; p<0,001). También se objetivó una mayor estancia media (22,15±13,67 vs. 10,64±7,53 días; p<0,001) junto con un incremento del coste hospitalario por paciente (7.517,71±4.639,59 vs. 3.611,21±2.609,98 euros, p<0,001). En el análisis multivariante, tras ajustar por edad, sexo y situación funcional y mental previa al ingreso, la infección por SAMR se asoció de forma independiente a mayor riesgo de muerte (Odds ratio [OR] = 3,92; intervalo de confianza [IC] al 95%=1,95–7,86), deterioro funcional al alta (OR=2,4; IC al 95%=1,22–5,01) e institucionalización (OR=6,50; IC al 95%=2,60–12,22), con incremento importante de la estancia hospitalaria (coeficiente beta=11,55 días; IC al 95%=9,32–13,75). Conclusión La infección por SAMR en la UGA se asocia a una mayor mortalidad, pérdida funcional y más frecuente institucionalización al alta hospitalaria, con importante incremento de la estancia y del coste hospitalario (AU)

ObjectiveThe aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU).Material and methodsWe retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record.ResultsData were obtained from 47 patients with MRSA (mean age 86.15±5.5 years) and from 4281 patients without MRSA (mean age 85.25±6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43±33.05 vs. 55.24±34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15±13.67 vs. 10.64±7.69 days, p<0.001) and higher hospital cost per patient (7517.71±4639.59 vs 3611.21±2609.98 €, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95–7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22–5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60–12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32–13.75).ConclusionMRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs(AU)