Related Experiment Video
Updated: Feb 16, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Readmissions With Multidrug-Resistant Infection in Patients With Prior Multidrug Resistant Infection
Jason P Burnham1, Jennie H Kwon1, Margaret A Olsen1
11Division of Infectious Diseases,Washington University School of Medicine,St Louis, Missouri.
Abstract:
OBJECTIVE To determine incidence of and risk factors for readmissions with multidrug-resistant organism (MDRO) infections among patients with previous MDRO infection. DESIGN Retrospective cohort of patients admitted between January 1, 2006, and October 1, 2015. SETTING Barnes-Jewish Hospital, a 1,250-bed academic tertiary referral center in St Louis, Missouri. METHODS We identified patients with MDROs obtained from the bloodstream, bronchoalveolar lavage (BAL)/bronchial wash, or other sterile sites. Centers for Disease Control and prevention (CDC) and European CDC definitions of MDROs were utilized. All readmissions ≤1 year from discharge from the index MDRO hospitalization were evaluated for bloodstream, BAL/bronchial wash, or other sterile site cultures positive for the same or different MDROs. RESULTS In total, 4,429 unique patients had a positive culture for an MDRO; 3,453 of these (78.0%) survived the index hospitalization. Moreover, 2,127 patients (61.6%) were readmitted ≥1 time within a year, for a total of 5,849 readmissions. Furthermore, 512 patients (24.1%) had the same or a different MDRO isolated from blood, BAL/bronchial wash, or another sterile site during a readmission. Bone marrow transplant, end-stage renal disease, lymphoma, methicillin-resistant Staphylococcus aureus, or carbapenem-resistant Pseudomonas aeruginosa during index hospitalization were factors associated with increased risk of having an MDRO isolated during a readmission. MDROs isolated during readmissions were in the same class of MDRO as the index hospitalization 9%-78% of the time, with variation by index pathogen. CONCLUSIONS Readmissions among patients with MDRO infections are frequent. Various patient and organism factors predispose to readmission. When readmitted patients had an MDRO, it was often a pathogen in the same class as that isolated during the index admission, with the exception of Acinetobacter (~9%). Infect Control Hosp Epidemiol 2018;39:12-19.
Insights
Readmissions with multidrug-resistant organism (MDRO) infections are common in patients previously infected. Specific patient factors and the type of MDRO increase the risk of readmission with these resistant infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Multidrug-resistant organisms (MDROs) pose a significant threat in healthcare settings.
- Understanding readmission patterns for patients with prior MDRO infections is crucial for infection control.
Purpose of the Study:
- To determine the incidence of readmissions involving MDRO infections.
- To identify risk factors associated with readmissions for patients with a history of MDRO infection.
Main Methods:
- Retrospective cohort study of patients admitted between 2006 and 2015.
- Analysis of bloodstream, respiratory, and sterile site cultures for MDROs during index hospitalization and readmissions within one year.
- Utilized Centers for Disease Control and Prevention (CDC) definitions for MDROs.
Main Results:
- Over 4,400 unique patients had MDROs; 61.6% were readmitted within a year.
- 24.1% of readmitted patients had an MDRO isolated from sterile sites.
- Factors like bone marrow transplant, end-stage renal disease, lymphoma, MRSA, and CR-Pseudomonas increased readmission risk with MDROs.
Conclusions:
- Readmissions are frequent for patients with prior MDRO infections.
- Patient comorbidities and specific MDRO types are key predictors of readmission with resistant organisms.
- MDROs during readmission were often in the same class as the initial infection, highlighting persistent susceptibility patterns.
Related Concept Videos
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
01:21Drug Accumulation During Multiple Dosing: Repetitive IV Injections
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion