Abstract
BackgroundHealthcare-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.MethodsA 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.Results341 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.ConclusionHCA 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.
Highlights
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
Respiratory tract infection as source of infection and inappropriate empirical therapy were associated with 14-day mortality only
A multivariate analysis of variables associated with 14day and 30-day mortality was performed
Summary
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. Previous studies associated HCA BSI with an increased risk for drugresistant organisms, inappropriate empirical therapy, and mortality, when compared to strict communityacquired (CA) episodes [4,6,8,9,11] Since these data were reported, various multidrug-resistant (MDR) organisms have emerged as a cause of strict community-acquired BSI (mainly extended-spectrum beta-lactamase [ESBL]-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus) [12,13]. The increased awareness that CO- BSI may be caused by specific antibiotic-resistant organisms would have led to the reduced risk of these patients receiving inappropriate therapy In this context, the objective of our study was to analyse the current etiology, therapy and outcomes for strict communityacquired (CA) and HCA bacteremia in our area
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