The distinct category of healthcare associated bloodstream infections.
The distinct category of healthcare associated bloodstream infections.
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DOI：
10.1186/1471-2334-12-85
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发表时间：
2012-04-09
影响因子：
3.7
通讯作者：
Laupland KB
中科院分区：
文献类型：
--
作者：
Lenz R;Leal JR;Church DL;Gregson DB;Ross T;Laupland KB
血流感染 (BSI) 传统上分为社区获得性感染 (CA) 或医院获得性感染 (HA)。然而，第三类医疗保健相关 (HCA) 社区发病疾病已得到越来越多的认识。本研究的目的是比较和对比 HCA-BSI 与 CA-BSI 和 HA-BSI 的特征。 2000 年至 2007 年间加拿大一个大型卫生区医院收治的所有首次 BSI 发作都是从区域数据库中确定的。使用一系列经过验证的算法将病例分类为 HA-BSI、HCA-BSI 或 CA-BSI 之一，并比较一些流行病学、微生物学和结果特征。总共纳入了 7,712 名患者； 2,132 例 (28%) 患有 HA-BSI，2,492 例 (32%) HCA-BSI，3,088 例 (40%) 患有 CA-BSI。与 HCA-BSI 或 HA-BSI 患者相比，CA-BSI 患者明显更年轻，并且患有共病的可能性更小 (p < 0.001)。与 HCA-BSI 或 CA-BSI（52% 和 54%；p = 0.13）相比，HA-BSI 的男性病例比例较高（60%；p < 0.001 与其他）。与 HA 和 HCA 相比（8.6% vs. 8.3%），CA-BSI 具有多种微生物病因的病例比例（5.5%；p < 0.001）显着较低。 BSI 诊断后的中位住院时间为：HA 为 15 天，HCA 为 9 天，CA 为 8 天（p < 0.001）。总体而言，引起血流感染的最常见菌种是大肠杆菌、金黄色葡萄球菌和肺炎链球菌。这些物种的分布和重要性的相对等级根据获取的分类而变化。 HA-BSI、HCA-BSI 和 CA-BSI 的 28 天全因病死率分别为 26%、19% 和 10%（p < 0.001）。基于许多流行病学、微生物学和结果特征，医疗保健相关的社区发病感染与 CA 和 HA 感染明显不同。这项研究进一步支持将社区发病的 BSI 分为单独的 CA 和 HCA 类别。
Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or hospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease has been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCA-BSI with CA-BSI and HA-BSI. All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada during 2000-2007 were identified from regional databases. Cases were classified using a series of validated algorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic, and outcome characteristics. A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had CA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than patients with HCA-BSI or HA-BSI (p < 0.001). The proportion of cases in males was higher for HA-BSI (60%; p < 0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54%; p = 0.13). The proportion of cases that had a poly-microbial etiology was significantly lower for CA-BSI (5.5%; p < 0.001) compared to both HA and HCA (8.6 vs. 8.3%). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p < 0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied according to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for HA-BSI, HCA-BSI, and CA-BSI, respectively (p < 0.001). Healthcare-associated community onset infections are distinctly different from CA and HA infections based on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support for the classification of community onset BSI into separate CA and HCA categories.
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影响因子：
4.5
作者：
Leal, Jenine;Gregson, Daniel B.;Laupland, Kevin B.
通讯作者：
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DOI：
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