J Korean Med Sci.  2010 Jul;25(7):992-998. 10.3346/jkms.2010.25.7.992.

Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals

• Son JS
• Song JH
• Ko KS
• Yeom JS
• Ki HK
• Kim SW
• Chang HH
• Ryu SY
• Kim YS
• Jung SI
• Shin SY
• Oh HB
• Lee YS
• Chung DR
• Lee NY
• Peck KR

• KMID: 1792946
• DOI: http://doi.org/10.3346/jkms.2010.25.7.992

Abstract

Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment.

Keyword

Bloodstream infection; Bacteremia; Community-acquired; Hospital-acquired; Healthcare-associated

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/therapeutic use
Bacteremia/drug therapy/*epidemiology/microbiology/mortality
Community-Acquired Infections/drug therapy/*epidemiology/microbiology/mortality
Cross Infection/drug therapy/*epidemiology/microbiology/mortality
Humans
Korea/epidemiology
Male
Middle Aged
Prospective Studies
Risk Factors
Treatment Outcome
Young Adult

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