The Distinct Category of Healthcare Associated Bloodstream Infections

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2012 Apr 11

PMID 22487002

Citations 51

Authors

Ryan Lenz

Jenine R Leal

Deirdre L Church

Daniel B Gregson

Terry Ross

Kevin B Laupland

Affiliations

Soon will be listed here.

Abstract

Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or hospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease has been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCA-BSI with CA-BSI and HA-BSI.

Methods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada during 2000-2007 were identified from regional databases. Cases were classified using a series of validated algorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic, and outcome characteristics.

Results: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had CA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than patients with HCA-BSI or HA-BSI (p < 0.001). The proportion of cases in males was higher for HA-BSI (60%; p < 0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54%; p = 0.13). The proportion of cases that had a poly-microbial etiology was significantly lower for CA-BSI (5.5%; p < 0.001) compared to both HA and HCA (8.6 vs. 8.3%). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p < 0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied according to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for HA-BSI, HCA-BSI, and CA-BSI, respectively (p < 0.001).

Conclusion: Healthcare-associated community onset infections are distinctly different from CA and HA infections based on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support for the classification of community onset BSI into separate CA and HCA categories.

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References

Son J, Song J, Ko K, Yeom J, Ki H, Kim S . Bloodstream infections and clinical significance of healthcare-associated bacteremia: a multicenter surveillance study in Korean hospitals. J Korean Med Sci. 2010; 25(7):992-8. PMC: 2890898. DOI: 10.3346/jkms.2010.25.7.992. View

Ortega M, Almela M, Soriano A, Marco F, Martinez J, Munoz A . Bloodstream infections among human immunodeficiency virus-infected adult patients: epidemiology and risk factors for mortality. Eur J Clin Microbiol Infect Dis. 2008; 27(10):969-76. DOI: 10.1007/s10096-008-0531-5. View

Laupland K, Church D, Vidakovich J, Mucenski M, Pitout J . Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect. 2008; 57(6):441-8. DOI: 10.1016/j.jinf.2008.09.034. View

Cheong H, Kang C, Kwon K, Heo S, Wi Y, Kim E . Clinical significance of healthcare-associated infections in community-onset Escherichia coli bacteraemia. J Antimicrob Chemother. 2007; 60(6):1355-60. DOI: 10.1093/jac/dkm378. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

Quan H, Parsons G, Ghali W . Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care. 2002; 40(8):675-85. DOI: 10.1097/00005650-200208000-00007. View

Lesens O, Hansmann Y, Brannigan E, Hopkins S, Meyer P, OConnel B . Healthcare-associated Staphylococcus aureus bacteremia and the risk for methicillin resistance: is the Centers for Disease Control and Prevention definition for community-acquired bacteremia still appropriate?. Infect Control Hosp Epidemiol. 2005; 26(2):204-9. DOI: 10.1086/502527. View

Diekema D, Beekmann S, Chapin K, Morel K, Munson E, Doern G . Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol. 2003; 41(8):3655-60. PMC: 179863. DOI: 10.1128/JCM.41.8.3655-3660.2003. View

Valles J, Calbo E, Anoro E, Fontanals D, Xercavins M, Espejo E . Bloodstream infections in adults: importance of healthcare-associated infections. J Infect. 2007; 56(1):27-34. DOI: 10.1016/j.jinf.2007.10.001. View

10.

McDonald J, Friedman N, Stout J, Sexton D, Kaye K . Risk factors for ineffective therapy in patients with bloodstream infection. Arch Intern Med. 2005; 165(3):308-13. DOI: 10.1001/archinte.165.3.308. View

11.

Yokoe D, Anderson J, Chambers R, Connor M, Finberg R, Hopkins C . Simplified surveillance for nosocomial bloodstream infections. Infect Control Hosp Epidemiol. 1998; 19(9):657-60. DOI: 10.1086/647894. View

12.

Leal J, Gregson D, Ross T, Flemons W, Church D, Laupland K . Development of a novel electronic surveillance system for monitoring of bloodstream infections. Infect Control Hosp Epidemiol. 2010; 31(7):740-7. DOI: 10.1086/653207. View

13.

Shorr A, Tabak Y, Killian A, Gupta V, Liu L, Kollef M . Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med. 2006; 34(10):2588-95. DOI: 10.1097/01.CCM.0000239121.09533.09. View

14.

Friedman N, Kaye K, Stout J, McGarry S, Trivette S, Briggs J . Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002; 137(10):791-7. DOI: 10.7326/0003-4819-137-10-200211190-00007. View

15.

Kollef M, Zilberberg M, Shorr A, Vo L, Schein J, Micek S . Epidemiology, microbiology and outcomes of healthcare-associated and community-acquired bacteremia: a multicenter cohort study. J Infect. 2011; 62(2):130-5. DOI: 10.1016/j.jinf.2010.12.009. View

16.

Liao C, Chen S, Chang S, Hsueh P, Hung C, Chen Y . Characteristics of community-acquired and health care-associated Staphylococcus aureus bacteremia in patients treated at the emergency department of a teaching hospital. Diagn Microbiol Infect Dis. 2005; 53(2):85-92. DOI: 10.1016/j.diagmicrobio.2005.06.009. View

17.

Garner J, Jarvis W, Emori T, Horan T, Hughes J . CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988; 16(3):128-40. DOI: 10.1016/0196-6553(88)90053-3. View

18.

Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A, Schwartz D . Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis. 2002; 34(11):1431-9. DOI: 10.1086/339809. View

19.

Horan T, Andrus M, Dudeck M . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32. DOI: 10.1016/j.ajic.2008.03.002. View

20.

Klevens R, Morrison M, Nadle J, Petit S, Gershman K, Ray S . Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007; 298(15):1763-71. DOI: 10.1001/jama.298.15.1763. View