Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections

BMC Infectious Diseases

Andrew F Shorr¹  Harlen D Hays²  Suzanne Fiske²  Matthew F Emons²  Rebecca S Campbell²  Brian H Nathanson³  Paresh Chaudhari⁴  Marya D Zilberberg⁵ 

[1] Washington Hospital Center, Washington, DC, USA;Cerner Corporation, Beverly Hills, CA, USA;OptiStatim LLC, Longmeadow, MA, USA;Astellas Pharma US, Inc, Deerfield, IL, USA;School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA

关键词: Hospitalization;    MRSA;    Clinical decision;    Prediction rule;    Skin infection;   

Others  :  1175337
DOI  :  10.1186/1471-2334-12-154

 received in 2012-01-17, accepted in 2012-06-25,  发布年份 2012

【 摘 要 】

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of complicated skin and skin structure infections (cSSSI). Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately.

Methods

We conducted a large multicenter (N=62 hospitals) retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA) infection risk factors.

Results

Of the 7,183 patients with cSSSI, 2,387 (33.2%) had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose–response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity.

Conclusions

MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.

【 授权许可】

   
2012 Zilberberg et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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