Comorbidity risk-adjustment measures were developed and validated for studies of antibiotic-resistant infections

Objectives: Comorbidities are often included in risk-factor models for nosocomial antibiotic-resistant bacterial infections, and aggregate comorbidity measures are valuable because they allow one variable to represent many. This study aimed to develop new aggregate comorbidity measures based upon the Chronic Disease Score (CDs) for assessing the comorbidity-attributable risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) nosocomial infections. Study Design and Setting: For each outcome, two retrospective cohort studies of hospitalized patients were conducted. Outcomes were a first MRSA or VRE positive clinical culture obtained 48 hours or more postadmission. Each cohort was divided into development (July 1998-2001) and validation (August 2001-2003) samples. New comorbidity measures were created for MRSA (CDS-MRSA), VRE (CDS-VRE), or any nosocomial infection outcome (CDS-ID) using logistic regression and subsequently validated. Model discrimination was measured using the c-statistic. Results: Discrimination of the CDS-MRSA (c = 0.60), CDS-VRE (c = 0.65), and CDS-ID (MRSA: c = 0.57; VRE: c = 0.64) was greater than that of the original CDs (MRSA: c = 0.52; VRE: c = 0.57). Conclusion: The CDS-MRSA, CDS-VRE, and CDS-ID are new infectious disease specific comorbidity risk-adjustment measures that will be useful for the quality of future epidemiologic studies of MRSA, VRE, and other infectious diseases. (C) 2006 Elsevier Inc. All rights reserved.