Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study
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
BMC Infectious Diseases 2013, 13:344 doi:10.1186/1471-2334-13-344Published: 24 July 2013
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.
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.
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.
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.