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The Burden of Staphylococcus aureus Infections on Hospitals in the United States
An Analysis of the 2000 and 2001 Nationwide Inpatient Sample Database
Gary A. Noskin, MD;
Robert J. Rubin, MD;
Jerome J. Schentag, PharmD;
Jan Kluytmans, MD, PhD;
Edwin C. Hedblom, PharmD;
Maartje Smulders, MS, MPH;
Elizabeth Lapetina, AB;
Eric Gemmen, MA
Arch Intern Med. 2005;165:1756-1761.
Background Previous studies have investigated the impact of Staphylococcus aureus infections on individual hospitals, but to date, no study using nationally representative data has estimated this burden.
Methods This is a retrospective analysis of the 2000 and 2001 editions of the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample database, which represents a stratified 20% sample of hospitals in the United States. All inpatient discharge data from 994 hospitals in 28 states during 2000 and from 986 hospitals in 33 states during 2001, representing approximately 14 million inpatient stays, were analyzed to determine the association of S aureus infections with length of stay, total charges, and in-hospital mortality.
Results Staphylococcus aureus infection was reported as a discharge diagnosis for 0.8% of all hospital inpatients, or 292 045 stays per year. Inpatients with S aureus infection had, on average, 3 times the length of hospital stay (14.3 vs 4.5 days; P<.001), 3 times the total charges ($48 824 vs $14 141; P<.001), and 5 times the risk of in-hospital death (11.2% vs 2.3%; P<.001) than inpatients without this infection. Even when controlling for hospital fixed effects and for patient differences in diagnosis-related groups, age, sex, race, and comorbidities, the differences in mean length of stay, total charges, and mortality were significantly higher for hospitalizations associated with S aureus.
Conclusions Staphylococcus aureus infections represent a considerable burden to US hospitals, particularly among high-risk patient populations. The potential benefits to hospitals in terms of reduced use of resources and costs as well as improved outcomes from preventing S aureus infections are significant.
Author Affiliations: Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, and Northwestern Memorial Hospital, Chicago, Ill (Dr Noskin); Department of Medicine, Division of Nephrology and Hypertension, Georgetown University, Washington, DC (Dr Rubin); School of Pharmacy, University of Buffalo, Buffalo, NY (Dr Schentag); Laboratory of Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands (Dr Kluytmans); 3M Medical Division, St Paul, Minn (Dr Hedblom); and Quintiles Strategic Research Services, Falls Church, Va (Mss Smulders and Lapetina and Mr Gemmen).
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