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Open Access Research article

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

Pilar Retamar1*, María Dolores López-Prieto2, Clara Nátera3, Marina de Cueto1, Enrique Nuño4, Marta Herrero5, Fernando Fernández-Sánchez6, Angel Muñoz7, Francisco Téllez8, Berta Becerril9, Ana García-Tapia10, Inmaculada Carazo11, Raquel Moya12, Juan E Corzo13, Laura León14, Leopoldo Muñoz15, Jesús Rodríguez-Baño116 and The Sociedad Andaluza de Enfermedades Infecciosas/Sociedad Andaluza de Microbiología y Parasitología Clínica and Red Española de Investigación en Enfermedades Infecciosas (SAEI/SAMPAC/REIPI) Bacteremia Group

Author Affiliations

1 Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Seville, Spain

2 Unidad Clínica de Microbiología y Enfermedades Infecciosas, Hospital del SAS, Jerez de la Frontera, Cádiz, Spain

3 Sección Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain

4 Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain

5 Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain

6 Servicio de Microbiología, Hospital Costa del Sol, Marbella, Málaga, Spain

7 Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, Spain

8 Unidad de Enfermedades Infecciosas, Hospital de La Línea, Cádiz, Spain

9 Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Punta de Europa, Algeciras, Cádiz, Spain

10 Servicio de Microbiología, Hospital Puerta del Mar, Cádiz, Spain

11 Servicio de Microbiología, Complejo Hospitalario de Jaén, Jaén, Spain

12 Servicio de Medicina Interna, Hospital de Antequera, Málaga, Spain

13 Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain

14 Servicio de Enfermedades Infecciosas, Hospital Torrecárdenas, Almería, Spain

15 Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain

16 Department of Medicine, University of Seville, Seville, Spain

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BMC Infectious Diseases 2013, 13:344  doi:10.1186/1471-2334-13-344

Published: 24 July 2013

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.

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