Epidemiology and Outcome of Nosocomial and Community-Onset Bloodstream Infection

Abstract

We performed a prospective study of bloodstream infection to determine factors independently associated with mortality. Between February 1999 and July 2000, 929 consecutive episodes of bloodstream infection at two tertiary care centers were studied. An ICD-9-based Charlson Index was used to adjust for underlying illness. Crude mortality was 24% (14% for community-onset versus 34% for nosocomial bloodstream infections). Mortality attributed to the bloodstream infection was 17% overall (10% for community-onset versus 23% for nosocomial bloodstream infections). Multivariate logistic regression revealed the independent associations with in-hospital mortality to be as follows: nosocomial acquisition (odds ratio [OR] 2.6, P < 0.0001), hypotension (OR 2.6, P < 0.0001), absence of a febrile response (P ‫؍‬ 0.003), tachypnea (OR 1.9, P ‫؍‬ 0.001), leukopenia or leukocytosis (total white blood cell count of <4,500 or >20,000, P ‫؍‬ 0.003), presence of a central venous catheter (OR 2.0, P ‫؍‬ 0.0002), and presence of anaerobic organism (OR 2.5, P ‫؍‬ 0.04). Even after adjustments were made for underlying illness and length of stay, nosocomial status of bloodstream infection was strongly associated with increased total hospital charges (P < 0.0001). Although accounting for about half of all bloodstream infections, nosocomial bloodstream infections account for most of the mortality and costs associated with bloodstream infection.Bloodstream infections cause substantial morbidity and mortality (7,18,24). Increasing rates of antimicrobial resistance (1, 6-8, 21), changing patterns of antimicrobial usage (8), and the wide application of new medical technologies (e.g., indwelling catheters and other devices) may change the epidemiology and outcome of bloodstream infection. It is therefore important to continually review and update the epidemiology and outcome of bloodstream infection, including an examination of the variables most strongly associated with mortality. Understanding these variables will help to prioritize resources and plan strategies for decreasing the mortality associated with bloodstream infection.We sought to determine the current epidemiology and outcome of bloodstream infection by prospectively evaluating consecutive patients at two large tertiary-care hospitals. Using multivariate models and controlling for underlying illness, we sought to determine which variables were most strongly and independently associated with mortality among patients with bloodstream infection. We were particularly interested in the relative contributions of nosocomial bloodstream infection to the overall mortality and costs associated with bloodstream infection.

Análisis de la monitorización de cinco indicadores de calidad del hemocultivo en un hospital universitario en Chile 2009-2011

“…Esta última varía entre 14 y 34%, dependiendo de si el origen del cuadro es comunitario o asociado a la atención en salud 1,2 . La bacteriemia causa frecuentemente sepsis y shock séptico, por lo que la administración precoz y apropiada de antimicrobianos infl uye directamente en el pronóstico del paciente 3,4 .…”

Sepse, sepse grave e choque séptico: aspectos clínicos, epidemiológicos e prognóstico em pacientes de Unidade de Terapia Intensiva de um Hospital Universitário

“…Os microrganismos mais importantes recuperados foram Staphylococcus coagulase-negativa (SCN) representando 30% e, Pseudomonas aeruginosa (8%), dados similares de estudos recentes 10,11 . Comparando com outros patógenos importantes, a presença de Candida sp (6%) foi compatível com estudos americanos 6 , por outro lado a presença de Enterococcus sp foi incomum (3,7%).…”

“…Nosso estudo, também, descreve a frequência de pacientes que evoluíram para óbito. Confirmamos o que foi publicado, recentemente, com taxas de mortalidade total nos casos de sepse, sepse grave e choque séptico de 16%, 20% e 46%, respectivamente 14 , na Europa, e 17% para sepse e 34% para sepse grave, nos estados 6,15 . Aqui, taxas similares foram descritas: 15,%, 34,6% e 50%, respectivamente.…”

The Utility of Rapid Microbiological and Molecular Techniques in Optimizing Antimicrobial Therapy

“…Studies have estimated the cost of treating BSIs to be approximately $27, 000 per patient for community-associated bloodstream infections (CABSIs) and between $58, 000 to $101, 000 per patient for healthcare-associated bloodstream infections (HABSIs) [3,4]. BSIs can quickly develop into life threatening situations such as sepsis and septic shock, requiring rapid identification of the causative pathogen to direct effective treatment [5].…”