Seasonal variation in health care-associated bloodstream infection: Increase in the incidence of gram-negative bacteremia in nonhospitalized patients during summer

Alcorn, Kylie; Gerrard, John; Macbeth, Deborough; Steele, Michael

doi:10.1016/j.ajic.2013.05.019

Cited by 19 publications

(23 citation statements)

References 11 publications

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“…Understanding the epidemiology of bloodstream infection due to Gram-negative bacteria is of great importance as the global spread of highly antimicrobial resistant strains is becoming more prevalent [17] . Previous single state or single country studies have demonstrated a greater incidence of bloodstream infection due to Gram-negative bacteria during warmer months [1] , [2] , [4] , [18] , [19] , [20] , [21] . This observation may reflect optimal growth conditions for many Gram-negative bacteria at 32–36°C.…”

Section: Discussionmentioning

confidence: 90%

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

et al. 2014

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ObjectiveInfections due to Gram-negative bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-negative bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability.DesignWe established a network of 23 international centers in 22 cities. Setting: De-identified results of positive blood cultures from 2007–2011 and data sources for geographic, climatic and socioeconomic factors were assembled for each center.ParticipantsPatients at the 23 centers with positive blood cultures.Main outcomeDue to variability in the availability of total culture volumes across sites, our primary outcome measure was the fraction of positive blood cultures that yielded Gram-negative bacteria; sources of variability in this outcome measure were explored using meta-regression techniques.ResultsThe mean fraction of bacteremia associated with Gram-negative bacteria was 48.4% (range 26.4% to 61.8%). Although not all sites displayed significant seasonality, the overall P-value for seasonal oscillation was significant (P<0.001). In univariate meta-regression models, temperature, latitude, latitude squared, longitude, per capita gross domestic product and percent of gross domestic product spent on healthcare were all associated with the fraction of bacteremia due to Gram-negative bacteria. In multivariable models, only percent of gross domestic product spent on healthcare and distance from the equator (ie. latitude squared) were significantly associated with the fraction of bacteremia due to Gram-negative bacteria.ConclusionsThe likelihood of bacteremia due to Gram-negative bacteria varies markedly between cities, in a manner that appears to have both geographic (latitude) and socioeconomic (proportion gross domestic product devoted to health spending) determinants. Thus, the optimal approach to initial management of suspected bacteremia may be geographically specific. The rapid emergence of highly antibiotic-resistant Gram-negative pathogens may have geographically specific impacts.

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Section: Discussionmentioning

confidence: 90%

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

et al. 2014

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“…Epidemiological studies in diabetes have demonstrated that hypoglycaemic episodes are more common during summer months, whilst hyperglycaemic complications are more common in the first months of the year, with said patterns ascribed to changes in calorie consumption and physical activity . Increased incidence of Gram‐negative bacteraemia has been reported in summer months and associated with elevated monthly outdoor temperatures . Community acquired pneumonia in contrast is more common in the spring and winter, as a result of the combination of circulating respiratory bacteria being more prevalent during colder seasons, and people spending more time indoors during colder months .…”

Section: Discussionmentioning

confidence: 99%

“…[41][42][43] Increased incidence of Gramnegative bacteraemia has been reported in summer months and associated with elevated monthly outdoor temperatures. [44][45][46] Community acquired pneumonia in contrast is more common in the spring and are more likely to be admitted with significant trauma during winter months, because of an increase in falls and accidents relating to ice/ snow. 49 It is likely that each of these aforementioned diseases influence the seasonal variation in AKI and further studies are required focusing on the precipitating factors which lead to AKI to provide a robust link between disease aetiology and the seasonal variation that we have described.…”

Section: Discussionmentioning

confidence: 99%

Seasonal pattern of incidence and outcome of Acute Kidney Injury: A national study of Welsh AKI electronic alerts

et al. 2017

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SummaryObjectives: To identify any seasonal variation in the occurrence of, and outcome following Acute Kidney Injury. Methods:The study utilised the biochemistry based AKI electronic (e)-alert system established across the Welsh National Health Service to collect data on all AKI episodes to identify changes in incidence and outcome over one calendar year (1st October 2015 and the 30th September 2016).Results: There were total of 48 457 incident AKI alerts. The highest proportion of AKI episodes was seen in the quarter of January to March (26.2%), and the lowest in the quarter of October to December (23.3%, P < .001). The same trend was seen for both community-acquired and hospital-acquired AKI sub-sets. Overall 90 day mortality for all AKI was 27.3%. In contrast with the seasonal trend in AKI occurrence, 90 day mortality after the incident AKI alert was significantly higher in the quarters of January to March and October to December compared with the quarters of April to June and July to September (P < .001) consistent with excess winter mortality reported for likely underlying diseases which precipitate AKI. Conclusions:In summary we report for the first time in a large national cohort, a seasonal variation in the incidence and outcomes of AKI. The results demonstrate distinct trends in the incidence and outcome of AKI.

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“…There has been speculation about the environmental changes that occur in warmer months for both the number and types of organisms found in the environment, and also regarding colonization of human skin. The in vitro optimal growth temperatures for several gram-negative organisms falls between 32˚C and 36˚C, making it intuitive to expect higher amounts of these organisms in the environment during summer [23].…”

Section: Plos Onementioning

confidence: 99%

Summer, sun and sepsis—The influence of outside temperature on nosocomial bloodstream infections: A cohort study and review of the literature

et al. 2020

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Background The incidence of many infections is seasonal e.g. surgical site infections, urinary tract infection and bloodstream infections. We questioned whether there is seasonal variation even in climate-controlled hospitalized patients, and analyzed the influence of climate parameters on nosocomial bloodstream infections. Methods and findings The retrospective cohort study is based on two databases: The German national surveillance system for nosocomial infections in intensive care units (ICU-KISS) from 2001 to 2015 and aggregated monthly climate data. Primary bloodstream infection (PBSI) is defined as a positive blood culture with one (or more) pathogen(s) which are not related to an infection on another site and which were not present at admission. Monthly infection data were matched with postal code, calendar month and corresponding monthly climate and weather data. All analyses were exploratory in nature. 1,196 ICUs reported data on PBSI to KISS. The ICUs were located in 779 hospitals and in 728 different postal codes in Germany. The majority of the 19,194 PBSI were caused by gram-positive bacteria. In total, the incidence density of BSI was 17% (IRR 1.168, 95%CI 1.076-1.268) higher in months with high temperatures (�20˚C) compared to months with low temperatures (<5˚C). The effect was most prominent for gram-negatives; more than one third (38%) higher followed by gram-positives with 13%. Fungi reached their highest IRR at moderately warm temperatures between 15-20˚C. At such temperatures fungi showed an increase of 33% compared to temperatures below 5˚C. PBSI spiked in summer with a peak in July and August. PBSI differed by pathogen: The majority of bacteria increased with rising temperatures. Enterococci showed no seasonality. S. pneumoniae reached a peak in winter time. The association of the occurrence of PBSI and temperatures �20˚C was stronger when the mean monthly temperature in the month PLOS ONE

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Seasonal variation in health care-associated bloodstream infection: Increase in the incidence of gram-negative bacteremia in nonhospitalized patients during summer

Cited by 19 publications

References 11 publications

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

Seasonal pattern of incidence and outcome of Acute Kidney Injury: A national study of Welsh AKI electronic alerts

Summer, sun and sepsis—The influence of outside temperature on nosocomial bloodstream infections: A cohort study and review of the literature

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