Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections
Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections
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DOI：
10.7326/0003-4819-137-10-200211190-00007
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发表时间：
2002-11-19
影响因子：
39.2
通讯作者：
Sexton, DJ
中科院分区：
文献类型：
--
作者：
Friedman, ND;Kaye, KS;Sexton, DJ
背景资料：血流感染发生在居住在社区的人，无论这些人是否已经在门诊接受医疗保健，传统上被归类为社区获得性感染。目的：开发一种新的血流感染分类方案，区分社区获得性，医疗保健相关性和医院感染。设计：前瞻性观察研究。设置：一个学术医疗中心和两个社区医院。患者：所有因血流感染入院的成人患者。测量：人口统计学特征、住院前的生活安排、合并症、血流感染的易感因素、住院日期、阳性血培养的日期和数量、微生物敏感性试验结果，出院或死亡日期，以及3至6个月随访时的死亡率。结果：504例血流感染患者入组; 143例（28%）社区获得性血流感染，186例（37%）医疗保健相关血流感染，175例（35%）医院内血流感染。在186例与医疗保健相关的血流感染患者中，29例居住在疗养院，64例接受家庭医疗保健，78例在家中或诊所接受静脉或血管内治疗，117例在血流感染前90天内住院。与社区获得性血流感染患者相比，医疗保健相关或医院内血流感染患者的癌症更常见。血管内器械是医疗保健相关感染和院内感染的最常见来源，金黄色葡萄球菌是这些类型感染中最常见的病原体。耐甲氧西林表皮葡萄金黄色葡萄球菌在医疗相关感染组（52%）和医院感染组（61%）中的发生率相似，但在社区获得性血流感染组（14%）中不常见（P = 0.001）。随访时，与医疗保健相关的感染患者的死亡率较高（29% vs 16%; P = 0.019）或医院感染（37%对16%; P < 0.001）比社区获得性感染患者。医疗保健相关血流感染在各种共病情况的频率、感染源、病原体及其易感性模式，以及随访时的死亡率。一个单独的类别为卫生保健相关的血流感染是合理的，这一新的类别将有明显的影响，经验性治疗和感染控制监测的选择。
Background: Bloodstream infections occurring in persons residing in the community, regardless of whether those persons have been receiving health care in an outpatient facility, have traditionally been categorized as community-acquired infections.Objective: To develop a new classification scheme for bloodstream infections that distinguishes among community-acquired, health care-associated, and nosocomial infections.Design: Prospective observational study.Setting: one academic medical center and two community hospitals.Patients: All adult patients admitted to the hospital with bloodstream infection.Measurements: Demographic characteristics, living arrangements before hospitalization, comorbid medical conditions, factors predisposing to bloodstream infection, date of hospitalization, dates and number of positive blood cultures, results of microbiological susceptibility testing, dates of hospital discharge or death, and mortality rates at 3 to 6 months of follow-up.Results: 504 patients with bloodstream infections were enrolled; 143 (28%) had community-acquired bloodstream infections, 186 (37%) had health care-associated bloodstream infections, and 175 (35%) had nosocomial bloodstream infections. Of the 186 patients with health care-associated bloodstream infection, 29 resided in a nursing home, 64 were receiving home health care, 78 were receiving intravenous or intravascular therapy at home or in a clinic, and 117 had been hospitalized in the 90 days before their bloodstream infection. Cancer was more common in patients with health care-associated or nosocomial bloodstream infection than in patients with community-acquired bloodstream infection. Intravascular devices were the most common source of health care-associated and nosocomial infections, and Staphylococcus aureus was the most frequent pathogen in these types of infections. Methicillin-resistant S. aureus occurred with similar frequency in the groups with health care-associated infection (52%) and nosocomial infection (61%) but was uncommon in the group with community-acquired bloodstream infection (14%) (P = 0.001). Mortality rate at follow-up was greater in patients with health care-associated infection (29% versus 16%; P = 0.019) or nosocomial infection (37% versus 16%; P < 0.001) than in patients with community-acquired infection.Conclusions: Health care-associated bloodstream infections are similar to nosocomial infections in terms of frequency of various comorbid conditions, source of infection, pathogens and their susceptibility patterns, and mortality rate at follow-up. A separate category for health care-associated bloodstream infections is justified, and this new category will have obvious implications for choices about empirical therapy and infection-control surveillance.