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Open Access Highly Accessed Research article

Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study

Ching Jou Lim14, Allen C Cheng24, David CM Kong14 and Anton Y Peleg34*

Author Affiliations

1 Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia

2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

3 Department of Microbiology, School of Biological Sciences, Monash University, Building 76, Wellington Road, Melbourne, Victoria 3800, Australia

4 Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia

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BMC Infectious Diseases 2014, 14:126  doi:10.1186/1471-2334-14-126

Published: 4 March 2014

Abstract

Background

Multidrug-resistant (MDR) organisms have been increasingly reported at hospital admission. Recognising the magnitude, trend and predictors for MDR organisms in community-onset bloodstream infections (COBSI) is crucial for guiding empiric antibiotic prescribing.

Methods

Positive blood culture isolates recovered from patients presenting to the emergency department during a ten-year period (1st Jan 2002-31st Dec 2011) were assessed. Trend analyses of MDR organisms were performed. Risk factors for COBSI caused by an MDR organism and predictors for 30-day mortality were also determined.

Results

A total of 1721 positive blood culture isolates were identified during the study period with a yearly incidence of 30-43 isolates/10 000 ED presentations. The proportion of MDR Escherichia coli causing COBSI increased from 9%-26% (Pā€‰<ā€‰0.001), whilst methicillin-resistant Staphylococcus aureus remained at high levels (20%-30%). A total of 360 patients were included in a matched case-control (1:1) study, and residents in long-term care facilities (adjusted odds ratio [AOR], 4.9 [95% CI, 2.1-11.6]), home wound care (AOR, 5.5 [95% CI, 1.6-18.7]), underlying immunosuppression (AOR, 3.5 [95% CI, 1.6-7.7]), recent surgery (AOR, 3.5 [95% CI, 1.1-11.6]), and exposure to antibiotics within 3 months (AOR, 5.5 [95% CI, 2.8-10.6]) were independently associated with MDR COBSI. High risk source of COBSI, age and Pitt bacteraemia score were independent predictors for 30-day mortality.

Conclusions

A concerning trend in MDR organisms causing bloodstream infection from the community is occurring. Risk factors for MDR organisms have been identified to assist in empiric antibiotic prescribing for those presenting to hospital with sepsis.

Keywords:
Multidrug-resistant; Empiric antibiotic therapy; Bacteraemia; Enterobacteriaceae; Staphylococcus