Clin Microbiol Infect. 2021 Dec 17:S1198-743X(21)00709-6. doi: 10.1016/j.cmi.2021.12.011. Online ahead of print.
ABSTRACT
OBJECTIVES: The effect of hospital-acquired bacteraemia on mortality is sparsely investigated. We investigated the incidence and hospital-acquired bacteraemia impact on mortality.
METHODS: We conducted a 13-year population-based cohort study using The North Denmark Bacteraemia Research Database and Danish health registries. The population comprised all adult patients with a hospital admission lasting ≥48 hours. We used Poisson regression to estimate trends in incidence. The 30-day mortality of hospital-acquired bacteraemia was estimated using an illness-death multi-state model with recovery using the population at risk of hospital-acquired bacteraemia as reference.
RESULTS: We identified 3,588 episodes of hospital-acquired bacteraemia in 484,264 admissions. The incidence increased proportionally by 1.02 episodes yearly (95% CI 1.01 - 1.03) between 2006 and 2018. Hospital-acquired bacteraemia was associated with increased mortality (adjusted hazard ratio (aHR) 4.32, 95% CI 3.95 - 4.72), especially hospital-acquired bacteraemia with unknown source (aHR 6.42 (95% CI 5.67 - 7.26), 'thoracic incl. pneumonia' (aHR 5.89, 95% CI 3.45 - 10.12), and abdominal source (aHR 4.33, 95% CI 3.27 - 5.74)95% CI95% CI. The relative impact on mortality diminished with age (aHR 5.66, 95% CI 2.00 - 16.01 in 18-40 years old vs. 3.69, 95% CI 3.14 - 4.32 in 81-105 years old) and comorbidity (aHR 5.75, 95% CI 4.45 - 7.42 in low vs. 3.55, 95% CI 3.16 -3.98 in high comorbidity), and was higher in elective admissions (aHR 9.09, 95% CI 7.14 - 11.57 vs. aHR of 4.03, 95% CI 3.67 - 4.42).
CONCLUSIONS: Hospital-acquired bacteraemia is associated with high mortality, especially when the source is unknown or originating from the thoracic cavity.
PMID:34929409 | DOI:10.1016/j.cmi.2021.12.011