Healthcare-associated bloodstream infection: A distinct entity? Insights from a large US database
Healthcare-associated bloodstream infection: A distinct entity? Insights from a large US database
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DOI：
10.1097/01.ccm.0000239121.09533.09
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发表时间：
2006-10-01
影响因子：
8.8
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Shorr, Andrew F.;Tabak, Ying P.;Kollef, Marin H.
Objective.为了更好地了解流行病学，微生物学，早发型，培养阳性，社区获得性，医疗保健相关，医院获得性血流infections.Design的结果：我们分析了一个大型的美国数据库（红衣主教健康，MediQual，以前，MedisGroups），以确定患者的细菌或真菌血流分离株从2002年至2003.Setting。数据集包括来自59家医院的管理和临床变量（生理、实验室、培养和其他临床）。在这些医院中，至少在入院前5天收集临床和培养数据，以确定血流感染。入院后2天内发生血流感染的患者被归类为社区获得性血流感染。那些在30天内住院，从另一个机构转移，正在进行化疗或长期血液透析的患者被归类为具有医疗保健相关的血流感染。入院第2天后发生的血流感染被归类为医院获得性血流感染。共有6，697名患者被确定为患有血流感染。测量和主要结果：医疗保健相关的血流感染占所有血流感染的一半以上（55.3%）。近三分之二（62.3%）的血流感染住院患者患有医院获得性血流感染或医疗保健相关的血流感染，其发病率和死亡率高于社区获得性血流感染患者。在所有血流感染病原体中，真菌与最高的粗死亡率、最长的住院时间和最高的总费用相关。在所有细菌性血流感染中，耐甲氧西林金黄色葡萄球菌与最高的粗死亡率（22.5%），最长的平均住院时间（11.1 +/- 10.7天）和最高的中位数总费用（36，109美元）相关。在控制了混杂因素后，耐甲氧西林S。金黄色葡萄球菌与最高的独立死亡风险相关（优势比2.70;置信区间2.03-3.58）。S.在所有类型的早发菌血症中，金黄色葡萄球菌是最常见的致病菌。医疗保健相关的血流感染构成了一个独特的实体的血流感染，其独特的流行病学，微生物学和结果。耐甲氧西林金黄色葡萄球菌在所有病原体中具有最高的相对死亡风险。
Objective. To gain a better understanding of the epidemiology, microbiology, and outcomes of early-onset, culture-positive, community-acquired, healthcare-associated, and hospital-acquired bloodstream infections.Design: We analyzed a large U.S. database (Cardinal Health, MediQual, formerly, MedisGroups) to identify patients with bacterial or fungal bloodstream isolates from 2002 to 2003.Setting. The data set included administrative and clinical variables (physiologic, laboratory, culture, and other clinical) from 59 hospitals. Bloodstream infections were identified in those hospitals collecting clinical and culture data for at least the first 5 days of admission.Patients. Patients with bloodstream infection within 2 days of admission were classified as having community-acquired bloodstream infection. Those with a prior hospitalization within 30 days, transfer from another facility, ongoing chemotherapy, or long-term hemodialysis were classified as having healthcare-associated bloodstream infection. Bloodstream infections that developed after day 2 of admission were classified as hospital-acquired bloodstream infection. A total of 6,697 patents were identified as having bloodstream infection.Interventions. None.Measurements and Main Results: Healthcare-associated bloodstream infection accounted for more than half (55.3%) of all bloodstream infections. Nearly two thirds (62.3%) of hospitalized patients with bloodstream infection suffered from either hospital-acquired bloodstream infection or healthcare-associated bloodstream infection and had higher morbidity and mortality rates than those with community-acquired bloodstream infection. Of all bloodstream infection pathogens, fungal organisms were associated with the highest crude mortality, longest length of stay in hospital, and greatest total charges. Of all bacterial bloodstream infections, methicillin-resistant Staphylococcus aureus was associated with the highest crude mortality rate (22.5%), the longest mean length of stay (11.1 +/- 10.7 days), and the highest median total charges ($36,109). After we controlled for confounding factors, methicillin-resistant S. aureus was associated with the highest independent mortality risk (odds ratio 2.70; confidence interval 2.03-3.58). S. aureus was the most commonly encountered pathogen in all types of early-onset bacteremia.Conclusions. Healthcare-associated bloodstream infection constitutes a distinct entity of bloodstream infection with its unique epidemiology, microbiology, and outcomes. Methicillin-resistant Staphylococcus aureus carries the highest relative mortality risk among all pathogens.