Table 2

Characterization of included studies that did not use the initial definition of HCAI[3]by focus of infection
Study, year of publication Study design HCAI criteria MDR* organisms Risk of bias
A. Bloodstream infections
Siegman-Igra et al., 2002 [7] Prospective, single center, 1,028 infections in 912 patients; Israel, 1 year 1. Discharge from hospital 2 to 30 days previously CAI HCAI HAI Moderate
2. Nursing-home acquired 8 (2) 24 (10) 71 (17)
3. Patients with long-term intravenous devices, for hemodialysis, chemotherapy or parenteral nutrition
4. Chronic hemodialysis
5. Invasive procedure previously or at hospital admission
Shorr et al., 2006 [11] Retrospective, multicenter, 6,697 patients; USA, 2 years 1. Prior hospitalization within 30 days CAI HCAI HAI Low
2. Transfer from another healthcare facility 152 (2) 397 (11) 62 (13)
3. Chronic hemodialysis
4. Immunosuppression medication or metastatic cancer
Kao et al., 2011 [30] Prospective, single center, 890 infections in 831 patients older than 14 years; Taiwan, 1 year 1. Hospitalized for 2 or more days in the previous 90 days CAI HCAI HAI High
2. Resided in a nursing home 11 (2) 41 (16) 42 (41)
3. Hemodialysis, intravenous chemotherapy or invasive procedures in the previous 90 days
Kollef et al., 2011 [12] Prospective, multicenter, 1,143 patients; USA, 1 year 1. Prior hospitalization within 6 months CAI HCAI Low
2. Admission from a skilled nursing facility 79 (19) 242 (33)
3. Hemodialysis
4. Immunosuppression
Al-Hasan et al., 2012 [31] Retrospective, multicenter, 733 episodes of gram negative bacteremia; excludes polymicrobial, nosocomial and recurrent episodes; USA, 10 years 1. Hospitalized for 2 or more days in the previous 90 days CAI HCAI Moderate
2. Residents in a nursing home or long-term care facility 12 28 (7)
3. Received intravenous therapy including ATB and chemotherapy
4. Hemodialysis in the previous 30 days
Lenz et al., 2012 [32] Retrospective, multicenter, 7,712 patients; only samples obtained in the first 5 days of hospital admission; Canada, 8 years 1. Hospitalized for 2 or more days in the previous 90 days CAI HCAI HAI Low
2. Nursing home or long term-care facility 59 (2) 158 (6) 202 (9)
3. Visit a hospital, clinic or emergency department within the prior 5 to 30 days
4. Hemodialysis
5. Active cancer
B. Pneumonia
Kollef et al., 2006 [13] Retrospective, multicenter, 4,543 patients with positive cultures within 5 days of hospital admission, USA, 2 years 1. Prior hospitalization within 30 days CAI HCAI HAI High
2. Admission from another care facility 624 (28) 537 (54) 362 (43)
3. Receiving long-term hemodialysis
Micek et al., 2007 [33] Retrospective, single center, 639 patients older than 16 years with positive cultures, Spain, 2 years 1. Hospitalization in the past 12 months CAI HCAI Low
2. Resident in a nursing home or long-term care facility or rehabilitation hospital 35 (17) 242 (56)
3. Outpatient hemodialysis, peritoneal dialysis or infusion therapies requiring regular visits to a clinic
4. Immunosuppression
Schreiber et al., 2010 [34] Retrospective, single center study, 190 patients needing mechanical ventilation more than 24 hours after hospital admission, patients without evidence of bacterial infection and patients transferred from other hospitals were excluded, USA, 4 years 1. Recent hospitalization (90 days) CAI HCAI Low
2. Admission from a long-term facility 17 (18) 48 (48)
3. Recent treatment with broad spectrum antibiotics (30 days)
4. Chronic hemodialysis
5. Wound care
6. Immunosuppression
Grenier et al., 2011 [14] Retrospective, single center study, 3,295 patients, those transferred from other hospitals or discharged from an acute care facility within 14 days were excluded, Canada, 12 years 1. Hospitalization in the past 90 days, but not in the last 14 days CAI HCAI Low
2. Resident of a nursing home or long-term care facility 42 (4) 21 (10)
3. Outpatient intravenous therapy or cancer therapy within the previous month
4. Long term hemodialysis
Guimarães et al., 2011 [35] Retrospective, single center study, 197 patients, Portugal, 1 year 1. Hospitalization for 2 days or more in the preceding 90 days CAI HCAI High
2. Resident of a nursing home or extended-care facility 2 (18) 9 (82)
3. Intravenous antibiotic therapy or chemotherapy within 30 days
4. Chronic dialysis within 30 days
5. Home wound care
6. Family member with multi-drug resistant pathogen
Chalmers et al., 2011 [36] Prospective, single center, 1,348 patients; Scotland, 4 years and 5 months 1. Hospitalization for 2 days or more in the preceding 90 days CAI HCAI High
2. Resident of a nursing home or extended-care facility 3 (1) 5 (6)
3. Home infusion therapy (including antibiotics and long-indwelling devices as catheters)
4. Chronic dialysis within 30 days
5. Home wound care
6. Family member with multi-drug resistant pathogen
Tasbakan et al., 2011 [37] Retrospective, single center study, 187 patients, Turkey, 1 year 1. Hospitalization for 2 days or more in the preceding 90 days CAI HCAI Low
2. Resident of a nursing home or extended-care facility 1 (13) 17 (44)
3. Home infusion therapy (including antibiotics)
4. Chronic dialysis within 30 days
5. Home wound care
6. Family member with multi-drug resistant pathogen
Ishida et al., 2012 [38] Retrospective, single center, 893 patients; Japan, 3 years 1. Discharged from a hospital in the preceding 90 days CAI HCAI Low
2. Resident in a nursing home or extended-care ward 6 (3) 37 (21)
3. A patient who regularly requires vascular access for dialysis, antimicrobial treatment, chemotherapy or immunosuppressive therapy in an outpatient setting
4. Elderly or handicap who needs long-term care with an ECOG of 3 or 4
Miyashita et al., 2012 [39] Prospective, multicenter, 1,385 patients; CAI and HCAI were considered until 72 h after hospital admission, Japan, 6 years 1. Discharged from a hospital in the preceding 90 days CAI HCAI High
2. Resident in a long-term nursing home setting or healthcare home 21 (4) 78 (20)
3. Continuous receiving endovascular therapy in an ambulatory setting (including dialysis, antibiotics, anticancer drugs and immunosuppression)
4. Elderly persons or physical disable persons who need healthcare
Wu et al., 2012 [40] Retrospective, multicenter study, 1,646 patients, those with pneumonia developing 2 days after admission or less than 14 days after the last hospitalization, with lung cancer obstructive pneumonia or HIV positive status with CD4+ t <200 were excluded, Taiwan,1 year 1. Undergoing repeated hospitalization within 90 days before CAI HCAI Low
2. Residing in a nursing home 122 (15) 169 (28)
3. Receiving radiation therapy or chemotherapy at an outpatient clinic
4. Received regular dialysis at an out patients clinic
Sugisaki et al., 2012 [41] Retrospective, single center study, 526 patients, Japan, 4 years 1. Hospitalization for 2 days or more in the preceding 90 days CAI HCAI Low
2. Resident of a nursing home or extended-care facility 50 (15) 72 (40)
3. Home infusion therapy (including antibiotics and long indwelling devices as catheters)
4. Chronic dialysis within 30 days
5. Home wound care
6. Family member with multi-drug resistant pathogen
Giannella et al., 2012 [42] Prospective, multicenter, 1,002 patients older than 16 years admitted into internal medicine departments, Spain, 2 weeks 1. Hospitalization in the past 180 days CAI HCAI HAI Low
2. Resident in a nursing home or extended-care facility 6 (4) 19 (29) 11 (52)
3. Attending a hospital regularly because of chronic underlying disease
4. Undergoing hemodialysis
5. Wound care or specialized nursing care in the past 30 days
6. Chemotherapy in the past 30 days
7. Surgery in the past 180 days
C. Other foci
Swenson et al., 2009 [43] Retrospective, single center study, 2,049 intra-abdominal infections; Canada, 10 year 1. Patients with a story of any hospitalization in the previous 30 days CAI HCAI High
2. Resident of a nursing home or rehabilitation facility in the previous 30 days 27 (7) 221 (28)
Merli et al., 2010 [44] Prospective, single center study, in 54 patients with cirrhosis, patients with HIV infection, under high dose of corticosteroid treatment or immunosuppressive therapy were excluded, Italy, 9 months 1. Hospitalization for 2 or more days or had undergone surgery during the preceding 180 days CAI HCAI HAI Low
2. Resident of a nursing home or long-term care facility 2 (50) 9 (82) 5 (45)
3. Attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the 30 days before
Ha et al., 2011 [45] Retrospective, single center study, in 319 patients with urinary infection; Korea, 1 year 1. Hospitalization for 2 or more days in an acute care hospital in the preceding 90 days CAI HCAI Low
2. Resident of a nursing home or long-term care facility 1 (1) 28 (14)
3. Received intravenous therapy, wound care or specialized nursing care at home in the previous 30 days
4. Attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the 30 days before
5. Received an invasive procedure, urological surgery or urethral catheterization in the previous 7 days
Sy et al., 2012 [46] Retrospective, multicenter study, in 1,536 patients with endocarditis; patients transferred from another hospital, recurrent admissions or day-stay admissions were excluded, Australia, 6 years 1. Hospitalization for 2 days or more in the preceding 90 days HCAI Non-HCAI High
2. Resident of a nursing home or in a long-term facility 40 (26) 61 (18)
3. Attended a hemodialysis clinic or received intravenous therapy in the 30 days before

*MDR = MRSA, Pseudomonas sp, Acinectobacter, Stenotrophomonas maltophilia, ESBL. CAI, community-acquired infection; ECOG, electrocochleography; HAI, hospital-acquired infection; HCAI, healthcare-associated infection; MDR, multidrug-resistant.

Cardoso et al.

Cardoso et al. BMC Medicine 2014 12:40   doi:10.1186/1741-7015-12-40

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