The epidemiology of bloodstream infection contributing to mortality: the difference between community-acquired, healthcare-associated, and hospital-acquired infections

• Published in: BMC infectious diseases 2022-04, Vol.22 (1), p.336-336, Article 336
• Main Authors: Mun, Seok Jun, Kim, Si-Ho, Kim, Hyoung-Tae, Moon, Chisook, Wi, Yu Mi
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Antimicrobial resistance; Bacilli; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteria; Bloodstream infection; Care and treatment; Catheters; Causes of; Community-Acquired Infections - drug therapy; Cross infection; Cross Infection - drug therapy; Data acquisition; Delivery of Health Care; Diagnosis; Drug resistance; Drug resistance in microorganisms; E coli; Empirical analysis; Epidemiology; Escherichia coli; Fungi; Gram-negative bacilli; Health care; Hospital-acquired infection; Hospitals; Hospitals, Teaching; Humans; Infections; Infectious diseases; Klebsiella; Klebsiella pneumoniae; Laboratories; Medical instruments; Mortality; Nosocomial infections; Pathogens; Patients; Population; Prevention; Public health; Retrospective Studies; Risk factors; Sepsis; Sepsis - drug therapy; Staphylococcus infections; Vancomycin; Variables; Variance analysis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-022-07267-9

The epidemiology of bloodstream infection (BSI) is well-established; however, little is known about the contribution of different pathogens to mortality. To understand true burden of BSI, pathogens contributing to mortality were investigated and compared according to where the BSI was acquired. Data from deceased patients in two teaching hospitals in the Republic of Korea were collected. BSI contributing mortality was defined as BSI within 2-weeks before death. Cases were grouped by acquisition sites: community-acquired (CA)-, healthcare-associated (HCA)-, and hospital-acquired (HA)-BSI. Drug resistance, BSI focus, and appropriateness of empirical antimicrobial therapy were also compared. Among 1849 deceased patients in the hospitals, 280 (15.1%) patients experienced BSI within 2-weeks before death. In all, 71, 53, and 156 patients in the CA-, HCA-, and HA-BSI groups, respectively, with 316 total isolated pathogens were analyzed. The three most common pathogens were Klebsiella pneumoniae (17.1%), Escherichia coli (16.4%), and Staphylococcus aureus (11.4%). While K. pneumoniae and E. coli were the most common pathogens in CA- and HCA-BSI, Acinetobacter baumannii and Candida species were in HA-BSI. 26.3% (41/156) of patients experienced breakthrough HCA-BSI during administration of carbapenem and/or vancomycin. The proportion of central venous catheter-related infection (0%, 3.4% and 28.3%), carbapenem resistant-Gram negative bacilli (0%, 6.9% and 21.9%), and inappropriate empirical antimicrobial therapy (21.1%, 37.7% and 51.9%; all P