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Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study

Healthcare-associated Gram-negative BSI

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Abstract

We performed a population-based study to examine the influence of healthcare-associated acquisition on pathogen distribution, antimicrobial resistance, short- and long-term mortality of community-onset Gram-negative bloodstream infections (BSI). We identified 733 unique patients with community-onset Gram-negative BSI (306 healthcare-associated and 427 community-acquired) among Olmsted County, Minnesota, residents from 1 January 1998 to 31 December 2007. Multivariate logistic regression was used to examine the association between healthcare-associated acquisition and microbiological etiology and antimicrobial resistance. Multivariate Cox proportional hazards regression was used to evaluate the influence of the site of acquisition on mortality. Healthcare-associated acquisition was predictive of Pseudomonas aeruginosa (odds ratio [OR] 3.14, 95% confidence intervals [CI]: 1.59–6.57) and the group of Enterobacter, Citrobacter, and Serratia species (OR 2.23, 95% CI: 1.21–4.21) as causative pathogens of community-onset Gram-negative BSI. Healthcare-associated acquisition was also predictive of fluoroquinolone resistance among community-onset Gram-negative bloodstream isolates (OR 2.27, 95% CI: 1.18–4.53). Healthcare-associated acquisition of BSI was independently associated with higher 28-day (hazard ratio [HR] 3.73, 95% CI: 2.13–6.93) and 1-year mortality (HR 3.60, 95% CI: 2.57–5.15). Because of differences in pathogen distribution, antimicrobial resistance, and outcomes between healthcare-associated and community-acquired Gram-negative BSI, identification of patients with healthcare-associated acquisition of BSI is essential to optimize empiric antimicrobial therapy.

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Acknowledgements

The authors thank Emily Vetter and Mary Ann Butler for providing us with vital data from the microbiology laboratory databases at the Mayo Clinic, Rochester and the Olmsted Medical Center. The authors thank Susan Schrage, Susan Stotz, R.N., and all the staff at the Rochester Epidemiology Project for their administrative help and support.

Funding

The study received funding from the Small Grants Program and the Baddour Family Fund at the Mayo Clinic, Rochester, MN, USA. The funding source had no role in study design.

This work was made possible by research grant R01-AG034676 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (National Institutes of Health, US Public Health Service).

Potential conflicts of interest

MNA, JEE, and LMB: No conflict.

MNA has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of Kentucky Medical Center, 800 Rose Street, Room MN 672, Lexington, KY, 40536, USA

    M. N. Al-Hasan

  2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    J. E. Eckel-Passow

  3. Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA

    L. M. Baddour

Authors
  1. M. N. Al-Hasan
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  2. J. E. Eckel-Passow
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  3. L. M. Baddour
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Correspondence to M. N. Al-Hasan.

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Al-Hasan, M.N., Eckel-Passow, J.E. & Baddour, L.M. Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study. Eur J Clin Microbiol Infect Dis 31, 1163–1171 (2012). https://doi.org/10.1007/s10096-011-1424-6

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  • DOI: https://doi.org/10.1007/s10096-011-1424-6

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