Korean J healthc assoc Infect Control Prev.  2017 Dec;22(2):43-55. 10.14192/kjhaicp.2017.22.2.43.

Analysis of Characteristics and Prognosis of Healthcare-Associated Secondary Bloodstream Infection

• Song JY
• Jeong IS
• Hyun S

• KMID: 2416030
• DOI: http://doi.org/10.14192/kjhaicp.2017.22.2.43

Abstract

BACKGROUND
Bloodstream infections are the most common type of healthcare-associated infections in which the proportion of secondary bloodstream infections (SBSIs) is noticeably high. SBSIs can result in negative patient outcomes and additional care costs. The purpose of this study was to describe the characteristics of SBSIs among hospitalized patients, identify potential predictors of SBSIs, and explore the prognoses of community-acquired and healthcare-associated SBSIs.
METHODS
This study was conducted with 237 adult patients with SBSIs in a general hospital in 2015.
RESULTS
The most common primary infection among SBSIs was urinary tract infection (UTI). The most common pathogens were Escherichia coli for UTI and Staphylococcus aureus for pneumonia. Mortality due to SBSIs was 4.24 times higher among patients in intensive care units than among those in general units; mortality also increased by 1.24 times as the APACHE II scores increased by 1 point.
CONCLUSION
Patients with UTI and pneumonia are at high risk for developing SBSIs. Further research is needed to identify risk factors for SBSIs by comparing SBSI and non-SBSI cases in a case-control study.

Keyword

Bacteremia; Infection; Infection control

MeSH Terms

Adult
APACHE
Bacteremia
Case-Control Studies
Escherichia coli
Hospitals, General
Humans
Infection Control
Intensive Care Units
Mortality
Pneumonia
Prognosis*
Risk Factors
Staphylococcus aureus
Urinary Tract Infections

Reference

1. Carrico R, Goss L, Suh KN. Association for Professionals in Infection Control and Epidemiology. In: APIC text of infection control and epidemiology. 4th ed. Washington: APIC; 2009. pp. 1-50.

2. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36:309–332.

3. Yoo JH. In: KONIS manual 2016. Seoul: Korean Society for Nosocomial Infection Control; 2016.

4. Korean Nosocomial Infections Surveillance System. ICU report. KONIS System. [Updated on 10 April 2017]. http://konis.cdc.go.kr/konis/sub/reports_icu.htm.

5. Ridgway JP, Sun X, Tabak YP, Johannes RS, Robicsek A. Performance characteristics and associated outcomes for an automated surveillance tool for bloodstream infection. Am J Infect Control. 2016; 44:567–571.

6. Picot-Guéraud R, Batailler P, Caspar Y, Hennebique A, Mallaret MR. Bacteremia caused by multidrug-resistant bacteria in a French university hospital center: 3 years of collection. Am J Infect Control. 2015; 43:960–964.

7. Korea Centers for Disease Control and Prevention (KCDC). Guideline for healthcare associated infection sample surveillance. Osong: Korea Centers for Disease Control and Prevention; 2012. pp. 1-59.

8. Korea Centers for Disease Control and Prevention (KCDC). Case definitions for national notifiable infectious disease. Osong: Korea Centers for Disease Control and Prevention; 2016. pp. 1-59.

9. Galpern D, Guerrero A, Tu A, Fahoum B, Wise L. Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery. 2008; 144:492–495.

10. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O\'Grady NP, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014; 35:753–771.

11. Park YH, Lee JC, Cho J, Park J, Shin M. A case of bilateral knee septic arthritis caused by pneumococcal bacteremia. Korean J Crit Care Med. 2013; 28:230–233.

12. Hwang SD, Park KS, Jeon BS, Kim YJ, Lee SH, Lee KS, et al. Clinical risk factors for bacteremia in patients with acute pyelonephritis. Korean J Nephrol. 2009; 28:418–423.

13. Raymond DP, Pelletier SJ, Crabtree TD, Gleason TG, Pruett TL, Sawyer RG. Impact of bloodstream infection on outcomes among infected surgical inpatients. Ann Surg. 2001; 233:549–555.

14. Girou E, Stephan F, Novara A, Safar M, Fagon JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med. 1998; 157:1151–1158.

15. Kim JH, Kim HJ, Lim YJ, Lee YH, Oh SH. Bloodstream infections in children with cancer between 2005 and 2008 in a single center. Korean J Pediatr Infect Dis. 2010; 17:36–48.

16. Watson CM, Al-Hasan MN. Bloodstream infections and central line-associated bloodstream infections. Surg Clin North Am. 2014; 94:1233–1244.

17. Ackermann RJ, Monroe PW. Bacteremic urinary tract infection in older people. J Am Geriatr Soc. 1996; 44:927–933.

18. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002; 137:791–797.

19. Paño-Pardo JR, López Quintana B, Lázaro Perona F, Ruiz Carrascoso G, Romero-Gómez MP, Loeches Yagüe B, et al. Community-onset bloodstream and other infections, caused by carbapenemase-producing Enterobacteriaceae: epidemiological, microbiological, and clinical features. Open Forum Infect Dis 2016;3:ofw136.

20. Shorr AF, Zilberberg MD, Micek ST, Kollef MH. Outcomes associated with bacteremia in the setting of methicillin-resistant Staphylococcus aureus pneumonia: a retrospective cohort study. Crit Care. 2015; 19:312.

21. Fortin E, Rocher I, Frenette C, Tremblay C, Quach C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Québec provincial surveillance results. Infect Control Hosp Epidemiol. 2012; 33:456–462.

22. Yoon PH, Cho EB, Kim SJ, Lee YH, Seo YH, Park YS. Comparison of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae bloodstream infection epidemiology. Korean J Nosocomial Infect Control. 2014; 19:45–51.

23. Falcone M, Russo A, Iraci F, Carfagna P, Goldoni P, Vullo V, et al. Risk factors and outcomes for bloodstream infections secondary to Clostridium difficile infection. Antimicrob Agents Chemother. 2015; 60:252–257.

24. Garbee DD, Pierce SS, Manning J. Opportunistic fungal infections in critical care units. Crit Care Nurs Clin North Am. 2017; 29:67–79.