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. 2012 Jun;31(6):1163-71.
doi: 10.1007/s10096-011-1424-6. Epub 2011 Oct 8.

Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study: healthcare-associated Gram-negative BSI

M N Al-Hasan  1 , J E Eckel-Passow, L M Baddour
Affiliations

Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study: healthcare-associated Gram-negative BSI

M N Al-Hasan et al. Eur J Clin Microbiol Infect Dis. 2012 Jun.

Abstract

We performed a population-based study to examine the influence of healthcare-associated acquisition on pathogen distribution, antimicrobial resistance, short- and long-term mortality of community-onset Gram-negative bloodstream infections (BSI). We identified 733 unique patients with community-onset Gram-negative BSI (306 healthcare-associated and 427 community-acquired) among Olmsted County, Minnesota, residents from 1 January 1998 to 31 December 2007. Multivariate logistic regression was used to examine the association between healthcare-associated acquisition and microbiological etiology and antimicrobial resistance. Multivariate Cox proportional hazards regression was used to evaluate the influence of the site of acquisition on mortality. Healthcare-associated acquisition was predictive of Pseudomonas aeruginosa (odds ratio [OR] 3.14, 95% confidence intervals [CI]: 1.59-6.57) and the group of Enterobacter, Citrobacter, and Serratia species (OR 2.23, 95% CI: 1.21-4.21) as causative pathogens of community-onset Gram-negative BSI. Healthcare-associated acquisition was also predictive of fluoroquinolone resistance among community-onset Gram-negative bloodstream isolates (OR 2.27, 95% CI: 1.18-4.53). Healthcare-associated acquisition of BSI was independently associated with higher 28-day (hazard ratio [HR] 3.73, 95% CI: 2.13-6.93) and 1-year mortality (HR 3.60, 95% CI: 2.57-5.15). Because of differences in pathogen distribution, antimicrobial resistance, and outcomes between healthcare-associated and community-acquired Gram-negative BSI, identification of patients with healthcare-associated acquisition of BSI is essential to optimize empiric antimicrobial therapy.

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Conflict of interest statement

Potential conflicts of interest MNA, JEE, and LMB: No conflict.

Figures

Fig. 1
Fig. 1
Incidence rate of community-onset Gram-negative bloodstream infection by age and site of acquisition in a female subjects and b male subjects, 1998–2007
Fig. 2
Fig. 2
Age- and sex-adjusted incidence rate of community-onset Gram-negative bloodstream infection by calendar year and site of acquisition
Fig. 3
Fig. 3
In vitro fluoroquinolone resistance rates of community-onset Gram-negative bloodstream isolates, by calendar year and site of acquisition. p value denotes a one-degree of freedom test for a linear trend using logistic regression
Fig. 4
Fig. 4
Kaplan–Meier a 28-day and b 1-year survival curves of patients with community-onset Gram-negative bloodstream infection by site of acquisition, 1998–2007. CA: community-acquired, HCA: healthcare-associated. p value denotes a difference in survival using the log-rank test
See this image and copyright information in PMC

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