Nosocomial, community and healthcare-associated bloodstream infections in Spain
Abstract number: O180
Retamar P., Rodríguez-Baño J., López-Prieto M.D., Portillo M.M., Rodríguez F., García M.V., Herrero M., Fernández F., Muñoz A., Sánchez A., Becerril B., Martín A., Alados J.C., Moya R., Florez C., León L., Escobar T., Arroyo A.
Objectives: Health care-associated (HCA) bloodstream infections (BSI) has been proposed as a new subclass of community-acquired (CA) BSI in USA. There are scarce data from other health care systems. We analysed the epidemiology and clinical features of bacteraemia according to acquisition in Andalucía, Spain.
Methods: A prospective multicentre cohort study including of all BSI episodes in 15 public hospitals (11 tertiary, 4 community) from Andalucía, Spain, from November 2005 throughout March 2006, was performed. BSI were classified as nosocomial (NOS), HCA or CA according to Friedman's criteria (Ann Intern Med 2002). Etiology, epidemiologic and clinical data were collected.
Results: 822 episodes of BSI were included: 476 (58%) were NOS, 227 (28%) HCA, and 119 (14%) CA. Chronic renal failure and liver disease were more frequent in HCA than in NOS (23% vs 9%, p < 0.001; and 13% vs 7%, p = 0.004); renal failure, cancer, and immunodeficiency were also more frequent in HCA than in CA. Venous catheter was more frequent in NOS than in HCA (87% vs 41%, p < 0.001). Urinary catheter use was similar in HCA and in CA (13% vs 13%, p = 0.9). The most frequent sources in NOS, HCA and CA were: unknown (27%, 23%, 14%), venous catheter (25%, 2%, 0), urinary tract (15%, 21%, 31%), gastrointestinal tract (14%, 21.6%, 22.2%), and respiratory tract (12%, 11%, 19%). The most frequent organisms in NOS, HCA and CA BSI were: Escherichia coli (20%, 37%, 36%), Streptococcus pneumoniae (1%, 6%, 18%), coagulase-negative staphylococci (CNS) (14%, 10%, 5%), Staphylococcus aureus (14%, 11%, 7%), and Pseudomonas aeruginosa (6%, 7%, 1%). Methicillin-resistant S. aureus (MRSA) was found in 3%, 5% and 0% of the episodes. Empirical treatment was appropriate in 69%, 81% and 84%, and mortality at day 14 was 20%, 19% and 15%, respectively.
Conclusion: There were significant differences between HCA and COM episodes. MRSA, CNS or P. aeruginosa caused BSI with similar frequency in NOS and HCA episodes, but were rare in COM BSI. HCA BSI should be considered as a distinct class within CA also in Spain.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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