Nosocomial bloodstream infection at a veterans hospital; 1979 to 1987.

Studies of nosocomial bloodstream infection (NBI) have come primarily from university, municipal or community hospitals with little specific information from veterans hospitals. The objective of this study was to define trends in NBI at a tertiary care veterans hospital. Patients with NBI were identified by retrospective review of microbiology records and of infection control surveillance records from 1979 to 1987 at the Buffalo Veterans Administration Medical Center (VAMC). Between 1979 and 1985 there was no significant upward or downward trend. Beginning in early 1986 a significant increase in NBI was noted. This increase was because of changes in incidence of gram-positive NBI (primarily Staphylococcus aureus [corrected] and enterococcus) while there was no change in incidence of gram-negative NBI. The most common source of NBI were similar to previous studies and included urinary tract infection, pneumonia, surgical wound infections and intravenous catheter related infections. The frequency of various organisms causing NBI was likewise similar to other studies except for pneumonia in which Streptococcus pneumoniae most commonly was isolated. The yearly incidence of gentamicin resistance among gram-negative NBI isolates demonstrated no significant trend. In conclusion, there was a significant increase in incidence of NBI at the Buffalo VAMC between 1979 and 1987 that occurred primarily in the last two years studied. The importance of gram-positive organisms as a cause of NBI at the Buffalo VAMC has been clearly documented as a recent phenomenon.