Epidemiology and Clinical Features of Community-Acquired, Healthcare Associated and Nosocomial Bloodstream Infections in Tertiary and Community Hospitals

Rodríguez‐Baño, Jesús; López-Prieto, María Dolores; Portillo, María M.; Retamar, Pilar; Nátera, Clara; Nuño, Enrique; Herrero, Marta; Arco, Alfonso del; Muñoz, Ángel Muñiz; Téllez, Francisco Ayuga; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, América; Ruíz, Ana; Moya, Raquel; Corzo, Juan E.; León, Laura Román García de; Pérez-López, José Antonio

doi:10.1111/j.1469-0691.2009.03089.x

Cited by 69 publications

(51 citation statements)

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“…were significantly less frequent and Streptococcus spp. significantly more frequent in HCA-BSI when compared to HA-BSI [23]. Differences were also found between CA- and HA-BSI for Streptococcus spp.…”

Section: Discussionmentioning

confidence: 75%

Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

et al. 2014

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PurposeThe objective of this study was to compare epidemiology, causative pathogens, outcome, and levels of laboratory markers of inflammation of community-onset (i.e. community-acquired and healthcare-associated) and hospital-acquired bloodstream infection (BSI) in South-East Austria.MethodsIn this prospective cohort study, 672 patients fulfilling criteria of systemic inflammatory response syndrome with positive peripheral blood cultures (277 community-onset [192 community-acquired, 85 healthcare-associated BSI], 395 hospital-acquired) were enrolled at the Medical University of Graz, Austria from 2011 throughout 2012. Clinical, microbiological, demographic as well as outcome and laboratory data was collected.Results Escherichia coli followed by Staphylococcus aureus were the most frequently isolated pathogens. While Streptococcus spp. and Escherichia coli were isolated more frequently in patients with community-onset BSI, Enterococcus spp., Candida spp., Pseudomonas spp., Enterobacter spp., and coagulase-negative staphylococci were isolated more frequently among those with hospital-acquired BSI. With regard to the outcome, 30-day (82/395 vs. 31/277; p = 0.001) and 90-day mortality (106/395 vs. 35/277; p<0.001) was significantly higher among patients with hospital-acquired BSI even though these patients were significantly younger. Also, hospital-acquired BSI remained a significant predictor of mortality in multivariable analysis. At the time the blood cultures were drawn, patients with community-onset BSI had significantly higher leukocyte counts, neutrophil-leucocyte ratios as well as C-reactive protein, procalcitonin, interleukin-6 and serum creatinine levels when compared to those with hospital-acquired BSI. Patients with healthcare-associated BSI presented with significantly higher PCT and creatinine levels than those with community-acquired BSI.ConclusionsHospital-acquired BSI was associated with significantly higher 30- and 90-day mortality rates. Hospital-acquired BSI therefore poses an important target for the most aggressive strategies for prevention and infection control.

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Section: Discussionmentioning

confidence: 75%

Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

et al. 2014

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“…As expected, the magnitude of the association was lower for 30-day than for 14-day mortality, meaning that the impact of adequate therapy is higher on early mortality. Since BSI affects between 100 and 200 people per 100,000 population-year and the incidence seems to be increasing (24,25,28), these results are relevant for the management of patients.…”

Section: Discussionmentioning

confidence: 99%

“…All consecutive episodes of clinically significant BSI in adult patients (Ͼ14 years old) from participating hospitals between 15 October 2006 and 15 December 2006 (tertiary centers) or 15 March 2007 (community centers) were included in the cohort. A detailed epidemiologic analysis of the cohort has been reported elsewhere (25).…”

Section: Methodsmentioning

confidence: 99%

Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

Retamar

Portillo

López-Prieto³

et al. 2012

Antimicrob Agents Chemother

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The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14-and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented.T he empirical antibiotic treatment of patients with potentially serious infections is a challenging task. Providing appropriate empirical coverage is proving more and more difficult as antibiotic resistance increases in both the hospital and the community (1). In such situations, physicians face a dilemma: to provide a very-broad-spectrum empirical coverage, accepting that on many occasions it will be excessive and might contribute to further resistance selection, or to use a narrower-spectrum empirical regimen, accepting that it may not cover the causative pathogen and might require correction once the susceptibility results are known (19).A key aspect of this decision-making process is the prognostic impact of empirical therapy. A meta-analysis recently showed reduced mortality rates for sepsis patients who received appropriate empirical therapy (22), although the studies analyzed were heterogeneous in terms of populations and types of infection covered. In both this study and another systematic review focusing on the methodological aspects of the topic (18), the need for new studies with improved methodologies was outlined. Bloodstream infection (BSI) has some advantages as a model for this kind of research. Although patients with bacteremia are only a subset of the pool of patients suffering ...

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“…Recently, the reemergence of Gram-negative organisms as a cause of primary BSIs has also been reported (1). In the United States, Escherichia coli is the fifth most common cause of nosocomial BSIs and is the first most common cause among Gram-negative organisms, and BSIs caused by E. coli are reported to be associated with a crude mortality rate of 22% (34); in Spain, it is the second most common cause of nosocomial BSIs (23).…”

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confidence: 99%

Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

et al. 2010

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Extended-spectrum-␤-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs)caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR] ‫؍‬ 4.8; 95% confidence interval [CI] ‫؍‬ 1.4 to 15.7), the previous use of oxyimino-␤-lactams (OR ‫؍‬ 6.0; 95% CI ‫؍‬ 3.0 to 11.8), and unknown BSI source (protective; OR ‫؍‬ 0.4; 95% CI ‫؍‬ 0.2 to 0.9), and duration of hospital stay (OR ‫؍‬ 1.02; 95% CI ‫؍‬ 1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR ‫؍‬ 3.9; 95% CI ‫؍‬ 1.2 to 12.9), a high-risk source (OR ‫؍‬ 5.5; 95% CI ‫؍‬ 1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR ‫؍‬ 6.5; 95% CI ‫؍‬ 1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-␤-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.Gram-negative organisms are an important cause of nosocomial bloodstream infections (BSIs) (33), particularly when the source of the BSI is the urinary, respiratory, or gastrointestinal tract. Recently, the reemergence of Gram-negative organisms as a cause of primary BSIs has also been reported (1). In the United States, Escherichia coli is the fifth most common cause of nosocomial BSIs and is the first most common cause among Gram-negative organisms, and BSIs caused by E. coli are reported to be associated with a crude mortality rate of 22% (34); in Spain, it is the second most common cause of nosocomial BSIs (23).In recent years, extended-spectrum ß-lactamases (ESBLs), particularly those of the CTX-M family, have spread worldwide among E. coli strains inside and outside hospitals (20,26); consequently, the prevalence of BSIs caused by ESBL-producing E. coli has significantly increased (24, 28). ESBLs confer resistance to penicillins and cephalosporins and are frequently associated with resistance to fluoroquinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (18); thus, ESBLproducing microorganisms are frequently truly multidrug resistant. Both antibiotic resistance a...

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Epidemiology and Clinical Features of Community-Acquired, Healthcare Associated and Nosocomial Bloodstream Infections in Tertiary and Community Hospitals

Cited by 69 publications

References 15 publications

Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

Characteristics of Hospital-Acquired and Community-Onset Blood Stream Infections, South-East Austria

Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

Risk Factors and Prognosis of Nosocomial Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

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