The outcome and timing of death of 17,767 nosocomial bloodstream infections in acute care hospitals in Finland during 1999–2014

Abstract

Few studies covering all patient groups and specialties are available regarding the outcome of nosocomial bloodstream infections (BSI). We analyzed the role of patient characteristics and causative pathogens of nosocomial BSIs reported by the hospitals participating in national surveillance in Finland during 1999-2014, in terms of outcome, with particular interest in those leading to death within 2 days (i.e. early death). National nosocomial BSI surveillance was laboratory-based and hospital-wide. Data on nosocomial BSIs was collected by infection control nurses, and dates of death were obtained from the national population registry with linkage to national identity codes. A total of 17,767 nosocomial BSIs were identified; 557 BSIs (3%) were fatal within 2 days and 1150 (6%) within 1 week. The 1-month case fatality was 14% (2460 BSIs), and 23% of the deaths occurred within 2 days and 47% within 1 week. The patients who died early were older than those who survived > 28 days, and their BSIs were more often related to intensive care. Gram-positive bacteria caused over half of the BSIs of patients who survived, whereas gram-negative bacteria, especially Pseudomonas aeruginosa, caused more often BSIs of patients who died early, and fungi BSIs of patients who died within 1 week. A significant portion of patients with nosocomial BSIs died early, which underlines the importance of rapid recognition of BSI. Hospital-wide surveillance data of causative pathogens can be utilized when composing recommendations for empiric antimicrobial treatment in collaboration with clinicians, as well as when promoting infection prevention.

Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020

“…Since these studies were single centre studies and/or included data from patients treated in academic medical centres, the representativeness of the included patients for the general hospital population in a given region or country was therefore unclear or low in these studies. Six studies [ 33 , 36 , 37 , 40 , 46 , 61 ] included nationally representative hospital populations. The risk of bias for the applied case definitions (i.e.…”

“…ranged between 14.3% and 32.3% (pooled estimate: 21.9%; 95% CI: 15.7–28.9, five studies) ( Figure 3 ; Table ). Based on two studies [ 40 , 47 ], the pooled all-cause mortality of patients with HA-BSI caused by VRE was 33.5% (95% CI: 13.0–57.3; range: 19.1–41.3). Importantly, Brady et al 2017 [ 7 ] provided data on the attributable mortality of HA-BSI with enterococci.…”

“…ranged between 14.3% and 32.3% (pooled estimate: 21.9%; 95% CI: 15.7-28.9, five studies) (Figure 3; Table ). Based on two studies [40,47], the pooled all-cause mortality of patients with HA-BSI caused by VRE was 33 4B; Supplementary Material, Table S6) in ICU. As reported by nine ICU studies [6,8,53,63,65,72,75,82,84], the proportion of VRE ranged between 0% and 1.8% (pooled estimate: 0.55%; 95% CI: 0.20-1.0).…”

Carbapenemase-producing Enterobacteriaceae in a Portuguese hospital – a five-year retrospective study

“…1 Enterobacteriaceae like Escherichia coli, Klebsiella pneumoniae and Enterobacter are some of the most common causes of community-and healthcare-associated infections. [2][3][4] The development of extended spectrum betalactamases (ESBL), plasmid-mediated Amp1 enzymes and deficiency of porins in the outer membrane, has led to important resistances to beta-lactams. 5,6 Therefore, carbapenems currently play a critically important role.…”

Healthcare-associated bloodstream infection trends under a provincial surveillance program

“…To our knowledge, the handful of hospital-wide HABSI surveillance programs in progress have been established in Belgium, 17,18 Finland, 19,20 Australia, 21,22 and Quebec, Canada. 23,24 In 2007, the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program was initiated in Quebec to monitor all HABSI in the province's acute-care hospitals.…”