Abstract
ObjectiveThe effect of hospital-acquired bacteraemia on mortality is sparsely investigated. We investigated the incidence and hospital-acquired bacteraemia impact on mortality. MethodsWe conducted a 13-year population-based cohort study using the North Denmark Bacteraemia Research Database and Danish health registries. The population comprised all adult patients with a hospital admission lasting ≥48 hr. We used Poisson regression to estimate trends in incidence. The 30-day mortality of hospital-acquired bacteraemia was estimated using an illness-death multistate model with recovery using the population at risk of hospital-acquired bacteraemia as reference. ResultsWe identified 3588 episodes of hospital-acquired bacteraemia in 484 264 admissions. The incidence increased proportionally by 1.02 episodes yearly (95% CI 1.01–1.03) between 2006 and 2018. Hospital-acquired bacteraemia was associated with increased mortality (adjusted hazard ratio (aHR) 4.32, 95% CI 3.95–4.72), especially hospital-acquired bacteraemia with unknown source (aHR 6.42 (95% CI 5.67–7.26), “thoracic incl. pneumonia” (aHR 5.89, 95% CI 3.45–10.12) and abdominal source (aHR 4.33, 95% CI 3.27–5.74). The relative impact on mortality diminished with age (aHR 5.66, 95% CI 2.00–16.01 in 18–40 years old vs. 3.69, 95% CI 3.14–4.32 in 81–105 years old) and comorbidity (aHR 5.75, 95% CI 4.45–7.42 in low vs. 3.55, 95% CI 3.16–3.98 in high comorbidity), and was higher in elective admissions (aHR 9.09, 95% CI 7.14–11.57 vs. aHR of 4.03, 95% CI 3.67–4.42). DiscussionHospital-acquired bacteraemia is associated with high mortality, especially when the source is unknown or originating from the thoracic cavity.
Highlights
Background/rationaleClearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers
Hospital-acquired bacteraemia was associated with increased mortality (adjusted hazard ratio 4.32, 95% CI 3.95 – 4.72), especially hospital-acquired bacteraemia with unknown source
Hospital-acquired bacteraemia is associated with high mortality, especially when the source is unknown or originating from the thoracic cavity
Summary
Exposures, predictors, potential confounders, and effect modifiers. For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group Sup. Bias. Describe any efforts to address potential sources of bias Study size. Explain how the study size was arrived at Quantitative variables
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