Between Community and Hospital: Healthcare-Associated Gram-Negative Bacteremia among Hospitalized Patients.
Infect Control Hosp Epidemiol. 2009 Oct 5;
Authors: Marschall J, Fraser VJ, Doherty J, Warren DK
Objective. Healthcare-associated, community-acquired bacteremia is a subcategory of community-acquired bacteremia distinguished by recent exposure of the patient to the healthcare system before hospital admission. Our objective was to apply this category to a prospective cohort of hospitalized patients with gram-negative bacteremia to determine differences in the epidemiological characteristics, treatment, and outcome of community-acquired bacteremia; healthcare-associated, community-acquired bacteremia; and hospital-acquired bacteremia. Design. A 6-month prospective cohort study. Setting. A 1,250-bed tertiary care hospital. Patients. Adults hospitalized with gram-negative bacteremia. Results. Among 250 patients, 160 (64.0%) had bacteremia within 48 hours after admission; 132 (82.5%) of these were considered to have healthcare-associated, community-acquired bacteremia, according to previously published criteria. For patients with healthcare-associated, community-acquired bacteremia, compared with patients with community-acquired bacteremia, malignancies (59 [44.7%] of 132 patients vs 3 [10.7%] of 28 patients; [Formula: see text]), open wounds at admission (42 [31.8%] vs 3 [10.7%]; [Formula: see text]), and intravascular catheter-related infections (26 [19.7%] vs 0; [Formula: see text]) were more frequent and Escherichia coli as a causative agent was less frequent (16 [57.1%] vs 33 [25.0%]; [Formula: see text]). There was no difference between these 2 groups in inadequate empirical antibiotic treatment (36 [27.3%] vs 6 [21.4%]; [Formula: see text]) and hospital mortality (18 [13.6%] vs 2 [[7.1%]; [Formula: see text]). Compared with 90 patients with hospital-acquired bacteremia, patients with healthcare-associated, community-acquired bacteremia had a higher Charlson score (odds ratio [OR], 1.31 [95% confidence interval (CI), 1.14-1.49]) but were less likely to have lymphoma (OR, 0.07 [95% CI, 0.01-0.51]), neutropenia (OR, 0.21 [95% CI, 0.07-0.61]), a removable foreign body (OR, 0.08 [95% CI, 0.03-0.20]), or Klebsiella pneumoniae infection (OR, 0.26 [95% CI, 0.11-0.62]). Conclusions. Many cases of gram-negative bacteremia that occurred in hospitalized patients were healthcare associated. The patients differed in some aspects from patients with community-acquired bacteremia and from those with hospital-acquired bacteremia, but not in mortality.
PMID: 19803723 [PubMed - as supplied by publisher]