Abstract |
Objective: Little data exist to differentiate gram negative healthcare-associated bacteremia from community-acquired bacteremia. The objective of this study was to apply this epidemiological type of bacteremia to a cross sectional study of hospitalized patients with community-onset gram negative bacteremia and to determine differences in the epidemiological characteristics, treatment and outcome of healthcare – associated and community-acquired bacteremia.
Methodology: We conducted a cross sectional study at the University Hospital of Heraklion. All adult patients with community-onset gram negative bacteremia were included, from 11 March 2010 to 23 November 2011. Bacteremia was classified as healthcare – associated and community-acquired using pre-defined selection criteria. We examined and compared patient demographic and clinical characteristics, therapy and outcome in both groups.
Results: Αmong 145 patients with community-onset gram negative bacteremia, 83 (57,2%) had healthcare – associated bacteremia (Healthcare-Associated Bacteremia-HCAB) and 62 (42,8%) had community-acquired (Community Acquired Bacteremia- CAB). For patients with HCAB compared with patients with CAB, malignant tumors (35 [42,2%] vs. 3 [4,8%]; Plt; .001), renal insufficiency (18 [21,7%] vs. 4 [6,5%]; Plt; .011) and dementia(14 [16,9%] vs. 3 [4,8%]; P=.026) were the most frequent comorbidities. In both groups Δ.Coli was more frequent a causative agent, and urinary tract was the most frequent source of infection. Patients with HCAB compared with patients with CAB had a higher Charlson score (mean [SD], 7 [2,7] vs. 4 [2,3]; Ple; .001), a higher Pitt bacteremia score (median [IQR], 3 [2-4] vs. 0 [0-1]; Ple; 001), higher
probability of death (26 [31,3%]) vs. (1 [1,6%]; Ple; 001) and less frequent administration of appropriate empirical antibiotic treatment (53 [63,9%] vs. 51 [82,3%]; P=.015). As far as antimicrobial resistance 27/83 (32,5%) and 4/62 (6,5%) of the gram negative bacteria that were isolated from HCAB and CAB respectively were resistant to third-generation cephalosporins (Plt;.001), 22/82 (26,8%) vs. 7/62 (11,3%) were resistant to aminoglycosides (P=.021), 29/82 (35,4%) vs. 9/62 (14,5%) were resistant to fluoroquinolones (P=.005), 16/76 (21,1%) vs. 2/59 (3,4%) were bacteria that produced ESBL (P=.003), 10/83 (12,0%) vs. 2/62 (3,2%) were resistant to carbapenems (P=.056) and 13/83 (15,7%) vs. 3/62 (4,8%) were multi-drug resistant (P=.040).
Conclusions: There are quite substantial differences between the two groups, which justifies the need to establish this classification based on the diversification of community-onset bacteremia in HCAB and CAB.
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