These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Between community and hospital: healthcare-associated gram-negative bacteremia among hospitalized patients.
    Author: Marschall J, Fraser VJ, Doherty J, Warren DK.
    Journal: Infect Control Hosp Epidemiol; 2009 Nov; 30(11):1050-6. PubMed ID: 19803723.
    Abstract:
    OBJECTIVE: Healthcare-associated, community-acquired bacteremia is a subcategory of community-acquired bacteremia distinguished by recent exposure of the patient to the healthcare system before hospital admission. Our objective was to apply this category to a prospective cohort of hospitalized patients with gram-negative bacteremia to determine differences in the epidemiological characteristics, treatment, and outcome of community-acquired bacteremia; healthcare-associated, community-acquired bacteremia; and hospital-acquired bacteremia. DESIGN: A 6-month prospective cohort study. SETTING: A 1,250-bed tertiary care hospital. PATIENTS: Adults hospitalized with gram-negative bacteremia. RESULTS: Among 250 patients, 160 (64.0%) had bacteremia within 48 hours after admission; 132 (82.5%) of these were considered to have healthcare-associated, community-acquired bacteremia, according to previously published criteria. For patients with healthcare-associated, community-acquired bacteremia, compared with patients with community-acquired bacteremia, malignancies (59 [44.7%] of 132 patients vs 3 [10.7%] of 28 patients; P = .001), open wounds at admission (42 [31.8%] vs 3 [10.7%]; P = .02), and intravascular catheter-related infections (26 [19.7%] vs 0; P = .009) were more frequent and Escherichia coli as a causative agent was less frequent (16 [57.1%] vs 33 [25.0%]; P = .001). There was no difference between these 2 groups in inadequate empirical antibiotic treatment (36 [27.3%] vs 6 [21.4%]; P = .5) and hospital mortality (18 [13.6%] vs 2 [[7.1%]; P = .5). Compared with 90 patients with hospital-acquired bacteremia, patients with healthcare-associated, community-acquired bacteremia had a higher Charlson score (odds ratio [OR], 1.31 [95% confidence interval (CI), 1.14-1.49]) but were less likely to have lymphoma (OR, 0.07 [95% CI, 0.01-0.51]), neutropenia (OR, 0.21 [95% CI, 0.07-0.61]), a removable foreign body (OR, 0.08 [95% CI, 0.03-0.20]), or Klebsiella pneumoniae infection (OR, 0.26 [95% CI, 0.11-0.62]). CONCLUSIONS: Many cases of gram-negative bacteremia that occurred in hospitalized patients were healthcare associated. The patients differed in some aspects from patients with community-acquired bacteremia and from those with hospital-acquired bacteremia, but not in mortality.
    [Abstract] [Full Text] [Related] [New Search]