Original Contribution | Published:

Inflammatory Bowel Disease

Increased Prevalence of and Associated Mortality With Methicillin-Resistant Staphylococcus aureus Among Hospitalized IBD Patients

The American Journal of Gastroenterology volume 105, pages 371377 (2010) | Download Citation




Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly prevalent in US hospitals, and the impact of MRSA on hospitalized inflammatory bowel disease (IBD) patients is unknown.


We used the Nationwide Inpatient Sample to identify admissions for IBD (n=116,842) between 1998 and 2004. We compared prevalence and in-hospital mortality of MRSA among IBD, non-IBD gastrointestinal (GI), and general medical inpatients.


MRSA prevalence increased from 4.5/10,000 to 19.0/10,000 over the 7-year period (P<0.0001). After adjustment for confounders, IBD inpatients were at increased risk of MRSA compared with the non-IBD GI (adjusted odds ratio (aOR) 1.61; 95% confidence interval (CI): 1.33–1.96) and general medical (aOR 1.36; 95% CI: 1.11–1.66) groups. Of those with MRSA, catheter-related infections were specifically more common among IBD compared with non-IBD GI and general inpatients (28.8% vs. 11.0% and 8.5%, respectively, P<0.0002). Bowel surgery, parenteral nutrition, and health insurance were predictors of MRSA infection, but the first two became insignificant after controlling for length of stay (LOS). Compared with LOS ≤ 7days, MRSA was more likely among those hospitalized 8–21 days (aOR 7.40; 95% CI: 4.68–11.7) and >21 days (aOR 58.6; 95% CI: 36.0–95.3). MRSA infection was associated with sevenfold increase in mortality (aOR 7.61; 95% CI: 3.33–17.4).


Hospitalized IBD patients are at increased risk of MRSA compared with non-IBD GI and general medical inpatients. Increased mortality in the IBD population associated with MRSA reinforces the importance of measures to prevent nosocomial infection and to reduce length of hospitalization.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , , et al. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:1443–1450.

  2. 2.

    , , et al. Incidence of Clostridium difficile infection in inflammatory bowel disease. Clin Gastroenterol Hepatol 2007;5:339–344.

  3. 3.

    , , . Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut 2008;57:205–210.

  4. 4.

    , , et al. Impact of Clostridium difficile on inflammatory bowel disease. Clin Gastroenterol Hepatol 2007;5:345–351.

  5. 5.

    , , . Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007;13:1840–1846.

  6. 6.

    , , . Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis 2008;14:929–931.

  7. 7.

    , , et al. The Simultaneous Burden of MRSA and CDAD in US Hospitals, 2003-2005. (Abstract # K-504) Abstract presented at the 2008 Annual Meeting of the ICAAC/IDSA. 2008; .

  8. 8.

    , , et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436–1444.

  9. 9.

    , , et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.

  10. 10.

    , , et al. Health care—associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 19 137:791–797.

  11. 11.

    , . The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.

  12. 12.

    , , . 2002 HCUP Nationwide Inpatient Sample (NIS) Comparison Report. U.S. Agency for Healthcare Research and Quality 2005. Jun 24. Report No.: 2005-03. 1–89 p.

  13. 13.

    , , et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005;43:1130–1139.

  14. 14.

    , , . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.

  15. 15.

    , , . Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 2002;40:675–685.

  16. 16.

    , , . Validity of procedure codes in International Classification of Diseases, 9th revision, clinical modification administrative data. Med Care 2004;42:801–809.

  17. 17.

    , , et al. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.

  18. 18.

    , , et al. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.

  19. 19.

    , , et al. Fluoroquinolones and risk for methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis 2006;12:1398–1405.

  20. 20.

    , , et al. Relationship between immunosuppression and intensive care unit-acquired multidrug-resistant bacteria: a case-control study. Crit Care Med 2007;35:1318–1323.

  21. 21.

    , , et al. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008;61:26–38.

  22. 22.

    , . Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002;49:999–1005.

  23. 23.

    , , et al. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003;9:1415–1422.

  24. 24.

    , , et al. Quality of colon cancer outcomes in hospitals with a high percentage of Medicaid patients. J Am Coll Surg 2008;207:197–204.

  25. 25.

    , , et al. Morbidity and mortality of colorectal carcinoma surgery differs by insurance status. Cancer 2004;101:2187–2194.

  26. 26.

    , , et al. Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer 2000;89:2202–2213.

  27. 27.

    , , et al. Quality of care for acute myocardial infarction at urban safety-net hospitals. Health Aff (Millwood ) 2007;26:238–248.

  28. 28.

    , , . Quality of care in hospitals with a high percent of Medicaid patients. Med Care 2007;45:579–583.

  29. 29.

    Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. In: Smedley BD, Stith AY, Nelson AR, et al., (eds). Washington, D.C.: National Academies Press, 2005 pp. 1–79.

  30. 30.

    , . Bias and causal associations in observational research. Lancet 2002;359:248–252.

  31. 31.

    , , et al. Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004. Inflamm Bowel Dis 2007;13:1529–1535.

  32. 32.

    , , . Trends in hospitalization rates for inflammatory bowel disease in the United States. Clin Gastroenterol Hepatol 2007;5:597–601.

Download references

Author information


  1. Mount Sinai Hospital IBD Centre, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada

    • Geoffrey C Nguyen
    •  & Harshna Patel
  2. Harvey M. and Lyn P. Meyerhoff IBD Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    • Geoffrey C Nguyen
  3. Department of Medicine, Lakeridge Health, Oshawa, Ontario, Canada

    • Rachel Y Chong


  1. Search for Geoffrey C Nguyen in:

  2. Search for Harshna Patel in:

  3. Search for Rachel Y Chong in:

Corresponding author

Correspondence to Geoffrey C Nguyen.

Supplementary information

About this article

Publication history






SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

Further reading