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

BMC Infectious Diseases

Jesús Rodríguez-Baño⁵  Leopoldo Muñoz⁹  Laura León^1,11  Juan E Corzo^1,14  Raquel Moya^1,12  Inmaculada Carazo⁴  Ana García-Tapia^1,16  Berta Becerril⁸  Francisco Téllez^1,13  Angel Muñoz^1,10  Fernando Fernández-Sánchez⁷  Marta Herrero⁶  Enrique Nuño²  Marina de Cueto¹  Clara Nátera³  María Dolores López-Prieto^1,15  Pilar Retamar¹ 

[1] Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Seville, Spain;Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain;Sección Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain;Servicio de Microbiología, Complejo Hospitalario de Jaén, Jaén, Spain;Department of Medicine, University of Seville, Seville, Spain;Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain;Servicio de Microbiología, Hospital Costa del Sol, Marbella, Málaga, Spain;Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Punta de Europa, Algeciras, Cádiz, Spain;Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain;Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, Spain;Servicio de Enfermedades Infecciosas, Hospital Torrecárdenas, Almería, Spain;Servicio de Medicina Interna, Hospital de Antequera, Málaga, Spain;Unidad de Enfermedades Infecciosas, Hospital de La Línea, Cádiz, Spain;Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain;Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain;Servicio de Microbiología, Hospital Puerta del Mar, Cádiz, Spain

关键词: Antimicrobial resistance;    Outcome;    Mortality;    Antimicrobial therapy;    Healthcare-associated;    Community-acquired;    Bacteremia;    Bloodstream infections;   

Others  :  1146781
DOI  :  10.1186/1471-2334-13-344

 received in 2012-09-25, accepted in 2013-07-17,  发布年份 2013

【 摘 要 】

Background

Healthcare-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.

Methods

A 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.

Results

341 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.

Conclusion

HCA 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.

【 授权许可】

   
2013 Retamar et al.; licensee BioMed Central Ltd.

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