Jordi Vallés1, Francisco Alvarez-Lerma2, Mercedes Palomar3, Armando Blanco4, Ana Escoresca5, Fernando Armestar6, José María Sirvent7, Carina Balasini8, Rafael Zaragoza9, María Marín10. 1. CIBER Enfermedades Respiratorias, Hospital Sabadell, Sabadell, Spain. Electronic address: jvalles@tauli.cat. 2. Hospital del Mar, Barcelona, Spain. 3. Hospital Vall d'Hebron, Barcelona, Spain. 4. Hospital Central de Asturias, Oviedo, Spain. 5. Hospital Virgen del Rocío, Sevilla, Spain. 6. Hospital Germans Trías i Pujol, Badalona, Spain. 7. Hospital Josep Trueta, Girona, Spain. 8. Hospital Interzonal General de Agudos "José de San Martín", La Plata, Argentina. 9. Hospital Peset, Valencia, Spain. 10. Hospital Valme, Sevilla, Spain.
Abstract
BACKGROUND: Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU. METHODS: This work was a multicenter, prospective, observational study of all adult patients with BSI at ICU admission at 27 Spanish hospitals and one Argentine hospital. Cases of BSI were classified as community-acquired BSI (CAB), health-care-associated BSI (HCAB), or hospital-acquired BSI (HAB), and their characteristics were compared. RESULTS: Of 726 BSIs, 343 (47.2%) were CABs, 252 (34.7%) were HABs, and 131 (18.0%) were HCABs. Potentially antibiotic-resistant pathogens were more frequently isolated in HABs (34.8%) and HCABs (27.6%) than in CABs (10.3%) (P < .001). Logistic regression analysis revealed that HABs (OR, 4.6; 95% CI, 2.9-7.3), HCABs (OR, 3.1; 95% CI, 1.8-5.4), and BSIs of unknown origin (OR, 1.7; 95% CI, 1.0-2.8) were independently associated with the isolation of potentially antibiotic-resistant pathogens. The incidence of inappropriate treatment was significantly higher in HABs (OR, 3.4; 95% CI, 2.1-5.3) and in HCABs (OR, 1.8; 95% CI, 1.0-3.2) than in CABs. CONCLUSIONS: One in five BSIs diagnosed at ICU admission is health-care-associated. The incidence of potentially drug-resistant pathogens in HCABs is more similar to that of HABs, and they should be treated as such until culture data are available.
BACKGROUND: Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU. METHODS: This work was a multicenter, prospective, observational study of all adult patients with BSI at ICU admission at 27 Spanish hospitals and one Argentine hospital. Cases of BSI were classified as community-acquired BSI (CAB), health-care-associated BSI (HCAB), or hospital-acquired BSI (HAB), and their characteristics were compared. RESULTS: Of 726 BSIs, 343 (47.2%) were CABs, 252 (34.7%) were HABs, and 131 (18.0%) were HCABs. Potentially antibiotic-resistant pathogens were more frequently isolated in HABs (34.8%) and HCABs (27.6%) than in CABs (10.3%) (P < .001). Logistic regression analysis revealed that HABs (OR, 4.6; 95% CI, 2.9-7.3), HCABs (OR, 3.1; 95% CI, 1.8-5.4), and BSIs of unknown origin (OR, 1.7; 95% CI, 1.0-2.8) were independently associated with the isolation of potentially antibiotic-resistant pathogens. The incidence of inappropriate treatment was significantly higher in HABs (OR, 3.4; 95% CI, 2.1-5.3) and in HCABs (OR, 1.8; 95% CI, 1.0-3.2) than in CABs. CONCLUSIONS: One in five BSIs diagnosed at ICU admission is health-care-associated. The incidence of potentially drug-resistant pathogens in HCABs is more similar to that of HABs, and they should be treated as such until culture data are available.
Authors: Alexis Tabah; Despoina Koulenti; Kevin Laupland; Benoit Misset; Jordi Valles; Frederico Bruzzi de Carvalho; José Artur Paiva; Nahit Cakar; Xiaochun Ma; Philippe Eggimann; Massimo Antonelli; Marc J M Bonten; Akos Csomos; Wolfgang A Krueger; Adam Mikstacki; Jeffrey Lipman; Pieter Depuydt; Aurélien Vesin; Maité Garrouste-Orgeas; Jean-Ralph Zahar; Stijn Blot; Jean Carlet; Christian Brun-Buisson; Claude Martin; Jordi Rello; Georges Dimopoulos; Jean-François Timsit Journal: Intensive Care Med Date: 2012-09-26 Impact factor: 17.440
Authors: Angela Hattemer; Alan Hauser; Maureen Diaz; Marc Scheetz; Nirav Shah; Jonathan P Allen; Jahan Porhomayon; Ali A El-Solh Journal: Antimicrob Agents Chemother Date: 2013-06-03 Impact factor: 5.191