Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study.

Anderson, Deverick J

Moehring, Rebekah W

Sloane, Richard

Schmader, Kenneth E

Weber, David J

Fowler, Vance G

Smathers, Emily

Sexton, Daniel J

Planet, Paul J

United States

2017-01-01T20:08:36Z

2014

BACKGROUND: While the majority of healthcare in the US is provided in community hospitals, the epidemiology and treatment of bloodstream infections in this setting is unknown. METHODS AND FINDINGS: We undertook this multicenter, retrospective cohort study to 1) describe the epidemiology of bloodstream infections (BSI) in a network of community hospitals and 2) determine risk factors for inappropriate therapy for bloodstream infections in community hospitals. 1,470 patients were identified as having a BSI in 9 community hospitals in the southeastern US from 2003 through 2006. The majority of BSIs were community-onset, healthcare associated (n = 823, 56%); 432 (29%) patients had community-acquired BSI, and 215 (15%) had hospital-onset, healthcare-associated BSI. BSIs due to multidrug-resistant pathogens occurred in 340 patients (23%). Overall, the three most common pathogens were S. aureus (n = 428, 28%), E. coli (n = 359, 24%), coagulase-negative Staphylococci (n = 148, 10%), though type of infecting organism varied by location of acquisition (e.g., community-acquired). Inappropriate empiric antimicrobial therapy was given to 542 (38%) patients. Proportions of inappropriate therapy varied by hospital (median = 33%, range 21-71%). Multivariate logistic regression identified the following factors independently associated with failure to receive appropriate empiric antimicrobial therapy: hospital where the patient received care (p<0.001), assistance with ≥3 ADLs (p = 0.005), Charlson score (p = 0.05), community-onset, healthcare-associated infection (p = 0.01), and hospital-onset, healthcare-associated infection (p = 0.02). Important interaction was observed between Charlson score and location of acquisition. CONCLUSIONS: Our large, multicenter study provides the most complete picture of BSIs in community hospitals in the US to date. The epidemiology of BSIs in community hospitals has changed: community-onset, healthcare-associated BSI is most common, S. aureus is the most common cause, and 1 of 3 patients with a BSI receives inappropriate empiric antimicrobial therapy. Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals.

http://www.ncbi.nlm.nih.gov/pubmed/24643200

PONE-D-13-34754

1932-6203

https://hdl.handle.net/10161/13315

eng

Public Library of Science (PLoS)

PLoS One

10.1371/journal.pone.0091713

Aged

Anti-Bacterial Agents

Bacteremia

Community-Acquired Infections

Cross Infection

Drug Resistance, Bacterial

Escherichia coli

Female

Gram-Negative Bacterial Infections

Hospitals, Community

Humans

Male

Medication Errors

Microbial Sensitivity Tests

Middle Aged

Pseudomonas aeruginosa

Retrospective Studies

Staphylococcal Infections

Staphylococcus aureus

United States

Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study.

Journal article

Anderson, Deverick J|0000-0001-6882-5496

Moehring, Rebekah W|0000-0001-7741-6029

Schmader, Kenneth E|0000-0001-5036-2155

Fowler, Vance G|0000-0002-8048-0897

Sexton, Daniel J|0000-0001-9604-5948

http://www.ncbi.nlm.nih.gov/pubmed/24643200

e91713

3

Basic Science Departments

Center for the Study of Aging and Human Development

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Geriatrics

Medicine, Infectious Diseases

Molecular Genetics and Microbiology

School of Medicine

Published online

9