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Epidemiology and Clinical Features of Community-Acquired, Healthcare Associated and Nosocomial Bloodstream Infections in Tertiary and Community Hospitals.
Clin Microbiol Infect. 2009 Oct 20;
Authors: Rodríguez-Baño J, López-Prieto MD, Portillo MM, Retamar P, Natera C, Nuño E, Herrero M, Del Arco A, Muñoz A, Téllez F, Torres-Tortosa M, Martín-Aspas A, Arroyo A, Ruiz A, Moya R, Corzo JE, León L, Pérez-López JA,
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 (TH) and community (CH) hospitals were investigated in a prospective cohort of 821 BSI episodes from 15 hospitals (10 TH and 5 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 1,000 admissions vs 2.2, p<0.01; HCA: 5.0 vs 2.9, p<0.01), whilst 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), but chronic ulcers were more frequent (22% vs 8%, p=0.008). BSIs due to methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa were very rare in CA episodes, but extended-spectrum beta-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 a separate class of BSI in both TH and CH, although differences between hospitals should be considered. CA BSIs were not caused by multidrug-resistant pathogens except for ESBLEC.
PMID: 19845694 [PubMed - as supplied by publisher]