Bloodstream infections in adults: Importance of healthcare-associated infections (original) (raw)
Related papers
Bloodstream Infections in a Community Hospital: A 25-Year Follow-Up
Infection Control and Hospital Epidemiology, 2003
Background: While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. Methods and Findings: We undertook this multicenter, retrospective cohort study to 1) describe the epidemiology of bloodstream infections (BSI) in a network of community hospitals and 2) determine risk factors for inappropriate therapy for bloodstream infections in community hospitals. 1,470 patients were identified as having a BSI in 9 community hospitals in the southeastern US from 2003 through 2006. The majority of BSIs were community-onset, healthcare associated (n = 823, 56%); 432 (29%) patients had community-acquired BSI, and 215 (15%) had hospital-onset, healthcare-associated BSI. BSIs due to multidrug-resistant pathogens occurred in 340 patients (23%). Overall, the three most common pathogens were S. aureus (n = 428, 28%), E. coli (n = 359, 24%), coagulase-negative Staphylococci (n = 148, 10%), though type of infecting organism varied by location of acquisition (e.g., community-acquired). Inappropriate empiric antimicrobial therapy was given to 542 (38%) patients. Proportions of inappropriate therapy varied by hospital (median = 33%, range 21-71%). Multivariate logistic regression identified the following factors independently associated with failure to receive appropriate empiric antimicrobial therapy: hospital where the patient received care (p,0.001), assistance with $3 ADLs (p = 0.005), Charlson score (p = 0.05), community-onset, healthcare-associated infection (p = 0.01), and hospital-onset, healthcareassociated infection (p = 0.02). Important interaction was observed between Charlson score and location of acquisition. Conclusions: Our large, multicenter study provides the most complete picture of BSIs in community hospitals in the US to date. The epidemiology of BSIs in community hospitals has changed: community-onset, healthcare-associated BSI is most common, S. aureus is the most common cause, and 1 of 3 patients with a BSI receives inappropriate empiric antimicrobial therapy. Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals.
The distinct category of healthcare associated bloodstream infections
BMC Infectious Diseases, 2012
Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or hospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease has been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCA-BSI with CA-BSI and HA-BSI. Methods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada during 2000-2007 were identified from regional databases. Cases were classified using a series of validated algorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic, and outcome characteristics. Results: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had CA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than patients with HCA-BSI or HA-BSI (p < 0.001). The proportion of cases in males was higher for HA-BSI (60%; p < 0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54%; p = 0.13). The proportion of cases that had a poly-microbial etiology was significantly lower for CA-BSI (5.5%; p < 0.001) compared to both HA and HCA (8.6 vs. 8.3%). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p < 0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied according to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for HA-BSI, HCA-BSI, and CA-BSI, respectively (p < 0.001). Conclusion: Healthcare-associated community onset infections are distinctly different from CA and HA infections based on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support for the classification of community onset BSI into separate CA and HCA categories.
Clinical Microbiology and Infection, 2010
Classification of bloodstream infections (BSIs) as community-acquired (CA), healthcare-associated (HCA) and hospital-acquired (HA) has been proposed. The epidemiology and clinical features of BSI according to that classification in tertiary-care (TH) and community (CH) hospitals were investigated in a prospective cohort of 821 BSI episodes from 15 hospitals (ten TH and five CH hospitals) in Andalucía, Spain. Eighteen percent were CA, 24% were HCA and 58% were HA. The incidence of CA and HCA BSI was higher in CH than in TH (CA: 3.9 episodes per 1000 admissions vs. 2.2, p <0.01; HCA: 5.0 vs. 2.9, p <0.01), whereas the incidence of HA BSI was lower (7.7 vs. 8.7, p <0.01). In CA and HCA BSI, the respiratory tract was more frequently the source in CH than in TH (CA: 30% vs. 15%; HCA: 20% vs. 9%, p £0.03). In HCA BSI, chronic renal insufficiency and tunnelled catheters were less frequent in CH than in TH (11% vs. 26% and 7% vs. 19%, p £0.03), although chronic ulcers were more frequent (22% vs. 8%, p 0.008). BSIs as a result of methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa were very rare in CA episodes, although extended-spectrum b-lactamase-producing Escherichia coli (ESBLEC) caused a similar proportion of all BSIs in CA, HCA and HA episodes. Multivariate analysis revealed no significant difference in mortality rates in CH and TH. HCA infections should be considered as a separate class of BSI in both TH and CH, although differences between hospitals must be considered. CA BSIs were not caused by multidrug-resistant pathogens, except for ESBLEC.
Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database*
Critical Care Medicine, 2006
To gain a better understanding of the epidemiology, microbiology, and outcomes of early-onset, culture-positive, community-acquired, healthcare-associated, and hospital-acquired bloodstream infections. Design: We analyzed a large U.S. database (Cardinal Health, MediQual, formerly MedisGroups) to identify patients with bacterial or fungal bloodstream isolates from 2002 to 2003. Setting: The data set included administrative and clinical variables (physiologic, laboratory, culture, and other clinical) from 59 hospitals. Bloodstream infections were identified in those hospitals collecting clinical and culture data for at least the first 5 days of admission. Patients: Patients with bloodstream infection within 2 days of admission were classified as having community-acquired bloodstream infection. Those with a prior hospitalization within 30 days, transfer from another facility, ongoing chemotherapy, or long-term hemodialysis were classified as having healthcare-associated bloodstream infection. Bloodstream infections that developed after day 2 of admission were classified as hospital-acquired bloodstream infection. A total of 6,697 patients were identified as having bloodstream infection. Interventions: None. Measurements and Main Results: Healthcare-associated bloodstream infection accounted for more than half (55.3%) of all bloodstream infections. Nearly two thirds (62.3%) of hospitalized patients with bloodstream infection suffered from either hospitalacquired bloodstream infection or healthcare-associated bloodstream infection and had higher morbidity and mortality rates than those with community-acquired bloodstream infection. Of all bloodstream infection pathogens, fungal organisms were associated with the highest crude mortality, longest length of stay in hospital, and greatest total charges. Of all bacterial bloodstream infections, methicillin-resistant Staphylococcus aureus was associated with the highest crude mortality rate (22.5%), the longest mean length of stay (11.1 ؎ 10.7 days), and the highest median total charges ($36,109). After we controlled for confounding factors, methicillin-resistant S. aureus was associated with the highest independent mortality risk (odds ratio 2.70; confidence interval 2.03-3.58). S. aureus was the most commonly encountered pathogen in all types of early-onset bacteremia. Conclusions: Healthcare-associated bloodstream infection constitutes a distinct entity of bloodstream infection with its unique epidemiology, microbiology, and outcomes. Methicillin-resistant Staphylococcus aureus carries the highest relative mortality risk among all pathogens.
Kafkas Journal of Medical Sciences, 2017
Aim: Bloodstream infections (BSIs) are an important cause of mortality in hospitals. Local surveillance data should be taken into account to overcome these challenging infections. The aim of this study is to determine the microbiological characteristics of BSIs and the risk factors for mortality. Material and Method: Active prospective surveillance data based on patient and laboratory were evaluated from January 2011 to June 2015. The first episodes of primary BSIs of the patients were included to the study. CDC case definitions were used to define BSIs. The data were recorded included demographics, underlying conditions, invasive procedures, fever (>=38°C) or hypothermia (<36°C), causative isolates and antimicrobial resistance patterns, appropriate antimicrobial therapy within 3 days after the onset of infection and outcome on day 14 after infection onset. Results: During the study period 373 patients with health care associated BSIs were identified. Acinetobacter spp. was the most common isolate (20.4%, n=76), followed by Coagulase negative Staphylocccus (CoNS) (19.3%, n=72), Candida spp. (17.2%, n=64) and Klebsiella spp. (11%, n=41), respectively. Multidrug resistance ratio was 98.7% for Acinetobacter spp. Methicillin resistance was found 66.7% of Staphylococcus aureus (S.aureus) and 79.2% of CoNS. Extended spectrum beta lactamases (ESBL) ratio for Klebsiella spp. was 65% (26/40) and 67.9% (19/28) for E.coli. The mortality rate of the patients in the first 14 days was 37.8% (n=141). Logistic regression analysis revealed that, BSIs due to the Acinetobacter spp. and Candida spp. had 2.35 and 2.48 times higher mortality rates, respectively. Inappropriate antimicrobial therapy, presence of hypothermia, steroid usage, dialysis and presence of two or more underlying conditions were other independent predictors for mortality. Conclusion: It is important to perform active surveillance for BSIs which result in high mortality rates due to resistant isolates. Appropriate antimicrobial therapy is crucial since it has a significant impact to decrease mortality.
Journal of Nursing & Care, 2017
Introduction: Inappropriate initial antimicrobial therapy leads to higher mortality in patients with bloodstream infection. This study aimed to evaluate the relationship between risk factors, etiology and antimicrobial therapy on mortality rates of patients with bloodstream infection. Methods: Between January 2016 to December 2016, 167 patients with bloodstream infection were prospectively evaluated according to the presence or absence of inappropriate antimicrobial therapy of infection. Hospital mortality was the main outcome variable compared between the two study groups. Results: Infected patients who received inappropriate antimicrobial therapy had statistically more diabetes mellitus, chronic obstructive pulmonary disease, chronic renal disease and death than infected patients who initially received appropriate antimicrobial therapy. Loading dose error and error in starting antimicrobial administration were the most frequently detected error in our study and both were determinant factors related to increased mortality. Initial antimicrobial therapy was maintained, escalation and de-escalation 67.6%, 22.7% and 9.6% of cases, respectively. Coagulase negative staphylococci represented the majority reaching 40.7% and multi-drug resistant microorganisms were detected in 27.3% of infections. There was no observed difference in mortality rates among infections caused by resistant or susceptible microorganisms. Conclusion: Loading dose error and error in starting antimicrobial administration, were the most frequently detected error in our study and both were determinant factors related to increased mortality. Beside the multiple logistic regression analysis revealed that the delay in starting antimicrobial therapy was the only independent factor that increased mortality.
Severe bloodstream infections: A population-based assessment*
Critical Care Medicine, 2004
Objective: Although bloodstream infection commonly results in critical illness, population-based studies of the epidemiology of severe bloodstream infection are lacking. We sought to define the incidence and microbiology of severe bloodstream infection (bloodstream infection associated with intensive care unit admission within 48 hrs) and assess risk factors for acquisition and death.
BMJ open, 2013
Hospital-acquired bloodstream infections are known to increase the risk of death and prolong hospital stay, but precise estimates of these two important outcomes from well-designed studies are rare, particularly for non-intensive care unit (ICU) patients. We aimed to calculate accurate estimates, which are vital for estimating the economic costs of hospital-acquired bloodstream infections. Case-control study. 9 Australian public hospitals. All the patients were admitted between 2005 and 2010. Risk of death and extra length of hospital stay associated with nosocomial infection. The greatest increase in the risk of death was for a bloodstream infection with methicillin-resistant Staphylococcus aureus (HR=4.6, 95% CI 2.7 to 7.6). This infection also had the longest extra length of stay to discharge in a standard bed (12.8 days, 95% CI 6.2 to 26.1 days). All the eight bloodstream infections increased the length of stay in the ICU, with longer stays for the patients who eventually died (...