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PLoS One. 2014 Mar 18;9(3):e91713. doi: 10.1371/journal.pone.0091713. eCollection 2014.

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

Author information

1
Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America; Duke Infection Control Outreach Network, Durham, North Carolina, United States of America.
2
Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America.
3
Department of Medicine-Geriatrics, Duke University Medical Center and Geriatric Research Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, North Carolina, United States of America.
4
Department of Hospital Epidemiology, University of North Carolina Health System, Chapel Hill, North Carolina, United States of America.
5
Duke University Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America.
6
Duke Infection Control Outreach Network, Durham, North Carolina, United States of America.

Abstract

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.

PMID:
24643200
PMCID:
PMC3958391
DOI:
10.1371/journal.pone.0091713
[Indexed for MEDLINE]
Free PMC Article
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