Characteristics of hospital-acquired and community-onset blood stream infections, South-East Austria.

Martin Hoenigl,Florian Prueller,Susanne Eigl,Reinhard B Raggam,Juergen Prattes,Robert Krause,Thomas Valentin,Andrea J Grisold,Ines Zollner-Schwetz,Eva Leitner,Katharina Hönigl,Jasmin Wagner,Michael A Polis

doi:10.1371/journal.pone.0104702

Abstract

PurposeThe objective of this study was to compare epidemiology, causative pathogens, outcome, and levels of laboratory markers of inflammation of community-onset (i.e. community-acquired and healthcare-associated) and hospital-acquired bloodstream infection (BSI) in South-East Austria.MethodsIn this prospective cohort study, 672 patients fulfilling criteria of systemic inflammatory response syndrome with positive peripheral blood cultures (277 community-onset [192 community-acquired, 85 healthcare-associated BSI], 395 hospital-acquired) were enrolled at the Medical University of Graz, Austria from 2011 throughout 2012. Clinical, microbiological, demographic as well as outcome and laboratory data was collected.Results Escherichia coli followed by Staphylococcus aureus were the most frequently isolated pathogens. While Streptococcus spp. and Escherichia coli were isolated more frequently in patients with community-onset BSI, Enterococcus spp., Candida spp., Pseudomonas spp., Enterobacter spp., and coagulase-negative staphylococci were isolated more frequently among those with hospital-acquired BSI. With regard to the outcome, 30-day (82/395 vs. 31/277; p = 0.001) and 90-day mortality (106/395 vs. 35/277; p<0.001) was significantly higher among patients with hospital-acquired BSI even though these patients were significantly younger. Also, hospital-acquired BSI remained a significant predictor of mortality in multivariable analysis. At the time the blood cultures were drawn, patients with community-onset BSI had significantly higher leukocyte counts, neutrophil-leucocyte ratios as well as C-reactive protein, procalcitonin, interleukin-6 and serum creatinine levels when compared to those with hospital-acquired BSI. Patients with healthcare-associated BSI presented with significantly higher PCT and creatinine levels than those with community-acquired BSI.ConclusionsHospital-acquired BSI was associated with significantly higher 30- and 90-day mortality rates. Hospital-acquired BSI therefore poses an important target for the most aggressive strategies for prevention and infection control.

Highlights

Despite advances in therapy and supportive care, bloodstream infection (BSI) still represents a major cause of morbidity and mortality [1,2,3,4,5,6,7,8,9] in patients presenting with systemic inflammatory response syndrome (SIRS)
A proportion (85/277 patients) was assigned to the subgroup of HCA-BSI, the remaining 192 patients to CA-BSI. Another 395 patients had been hospitalized for at least 48 hours at the time the positive blood cultures were collected. These patients were assigned to the HA-BSI group
No difference for age was found between CA- and HCA-BSI

Summary

Introduction

Despite advances in therapy and supportive care, bloodstream infection (BSI) still represents a major cause of morbidity and mortality [1,2,3,4,5,6,7,8,9] in patients presenting with systemic inflammatory response syndrome (SIRS). In a population-based study the incidence of BSI was found to be 15.7/100 000 patients per year [10]. Estimations suggest that more than 23.000 people died of Staphylococcus aureus and Escherichia coli bacteremias in Europe in 2007 [11]. In Europe, incidence rates of BSIs caused by the five major pathogens (i.e. Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium) have been increasing. De Kraker and colleagues reported that BSI incidence increased from 0.58/1000 patient-days in 2002 to 0.90/1000 patient-days in 2008 (7.2% per year; 95% CI 6.9– 7.5%).

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