Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study

Abstract

BackgroundHealthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area.MethodsA prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006–2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression.Results341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found.ConclusionHCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.

The lung is a host defense niche for immediate neutrophil-mediated vascular protection

“…Bloodstream infections are common both in the community (3)(4)(5) and in the hospital (6)(7)(8)(9). Escherichia coli is a major overall causative organism found in community-acquired and hospital-acquired bloodstream infections (3,10). Alarmingly, Gram-negative bacteria are rapidly developing resistance to broadspectrum antibiotics and, in some circumstances, have become panantibiotic-resistant (11,12).…”

Clinical value of FDG-PET/CT in bacteremia of unknown origin with catalase-negative gram-positive cocci or Staphylococcus aureus

“…Only few studies have investigated bacteremia of unknown origin (BUO) [8] despite its frequent occurrence at an estimated 8-22% of bacteremia cases [9][10][11]. Studies have pointed towards increased mortality when the origin of bacteremia is unknown/undetermined [12][13][14], underlining the importance of locating the primary site of infection in BUO.…”

Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary

“…Retamar et al examined 341 episodes of community-onset bloodstream infections, and they found that 6.3% were caused by MDR isolates, from which 3.8% were ESBL producers. Again, MRSA was not reported as a causative agent [28]. However, we note that some authors document MDR organisms as possible etiologies at higher rates, but these results should be interpreted with caution.…”