Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation

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

Pilar Retamar et al. BMC Infect Dis. .

Abstract

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.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bearman RP, Wenzel GML. Bacteremias: a leading cause of death. Arch Med Res. 2005;36:646–659. doi: 10.1016/j.arcmed.2005.02.005. - DOI - PubMed
    1. Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E. et al.Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother. 2010;54:4851–4863. doi: 10.1128/AAC.00627-10. - DOI - PMC - PubMed
    1. Retamar P, Portillo MM, López-Prieto MD, Rodríguez-López F, de Cueto M. et al.Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis. Antimicrob Agents Chemother. 2012;56:472–478. doi: 10.1128/AAC.00462-11. - DOI - PMC - PubMed
    1. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL. et al.Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;130:791–797. - PubMed
    1. Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A. et al.Reappraisal of community acquired bacteremia: a proposal for a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis. 2002;34:1431–1439. doi: 10.1086/339809. - DOI - PubMed

Publication types

Substances