Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals
J Rodríguez-Baño, M D López-Prieto, M M Portillo, P Retamar, C Natera, E Nuño, M Herrero, A del Arco, A Muñoz, F Téllez, M Torres-Tortosa, A Martín-Aspas, A Arroyo, A Ruiz, R Moya, J E Corzo, L León, J A Pérez-López, SAEI/SAMPAC Bacteraemia Group, F Rodríguez, Marina de Cueto, María V García, Verónica González-Galán, Fernando Fernández-Sánchez, María J Gutiérrez, Antonio Sánchez-Porto, Berta Becerril, Ana García-Tapia, Juan C Alados, Federico Acosta, Carmen Florez, Petra Navas, María A Martínez-Pérez, Inmaculada Carazo, J Rodríguez-Baño, M D López-Prieto, M M Portillo, P Retamar, C Natera, E Nuño, M Herrero, A del Arco, A Muñoz, F Téllez, M Torres-Tortosa, A Martín-Aspas, A Arroyo, A Ruiz, R Moya, J E Corzo, L León, J A Pérez-López, SAEI/SAMPAC Bacteraemia Group, F Rodríguez, Marina de Cueto, María V García, Verónica González-Galán, Fernando Fernández-Sánchez, María J Gutiérrez, Antonio Sánchez-Porto, Berta Becerril, Ana García-Tapia, Juan C Alados, Federico Acosta, Carmen Florez, Petra Navas, María A Martínez-Pérez, Inmaculada Carazo
Abstract
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.
© 2010 The Authors. Journal Compilation © 2010 European Society of Clinical Microbiology and Infectious Diseases.
Source: PubMed