An analysis of 7 years of blood cultures: epidemiology, microbiology and mortality
Abstract
Abstract
Background: We sought to analyze the epidemiology, microbiology and outcomes of medical patients with blood cultures collected.
Methods: Analysis of prospectively collected data from internal medicine admissions with and without blood cultures collected over 7 years at Tel Aviv Sourasky Medical Centre in Israel.
Results: Blood cultures were drawn in 35% of medical admissions. Twenty one percent of admissions with blood cultures collected had at least 1 positive blood culture, 6621 admissions (4%) had at least 1 bloodstream infection (BSI), while 5908 admissions (3.5%) yielded a blood culture contaminant. Seventy-three percent of BSIs were of community-onset, and 27% were hospital-acquired. The most common pathogens responsible for BSI were Escherichia coli, Staphylococcus aureus, and Klebsiella pneumoniae. Forty two percent of S. aureus BSI episodes were caused by methicillin-resistant strains, while among K. pneumoniae BSI episodes, 49.4% were caused by extended-spectrum β lactamase producers, and 5.6% were caused by carbapenem-resistant strains. Patients with BSI were of older age, had lower Norton risk scale scores and their length of hospital stay, 30-day and 1-year mortality rates were approximately 2.5 times higher than the overall internal medical patient group. Hospital-acquired BSI in particular carried a substantially higher length of stay and mortality.
Conclusions: Among medical admissions of median age 73 years, the incidence of BSI was 4%. Nearly three-quarters of BSIs were of community-onset. MRSA and ESBL-producers accounted for half of S. aureus and K. pneumoniae BSI episodes. Patients with BSI, particularly hospital-acquired BSI, spend longer in hospital and have substantially higher mortality.
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Libman E. On some experiences with blood cultures in the study of bacterial infections. Bulletin of the Johns Hopkins Hospital 1906;17:215-28.
Libman E. The etiology of subacute infective endocarditis. Am J Med Sci 1910;140:516-26.
Alahmadi YM, Aldeyab MA, McElnay JC, Scott MG, Darwish FW, Magee FA, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011;77:233-6.
Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther 2012;10:701-6.
Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Population-based assessment of intensive care unit-acquired bloodstream infections in adults: incidence, risk factors, and associated mortality rate. Crit Care Med 2002;30:2462-7.
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The Clinical Significance of Positive Blood Cultures in the 1990s: A Prospective Comprehensive Evaluation of the Microbiology, Epidemiology, and Outcome of Bacteremia and Fungemia in Adults. Clin Infect Dis 1997;24:584-602.
Weinstein MP, Murphy JR, Reller LB, Lichtenstein KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults; I. Laboratory and epidemiologic observations. Rev Infect Dis 1983;5:35-53.
Reith AF, Squier TL. Blood cultures of apparently healthy persons. J infect Dis 1932;51:336-43.
Darby JM, Linden P, Pasculle W, Saul M. Utilization and diagnostic yield of blood cultures in a surgical intensive care unit. Crit Care Med 1997;25:989-94.
Roberts FJ, Geere IW, Coldman A. A three-year study of positive blood cultures, with emphasis on prognosis. Rev Infect Dis 1991;13:34-46.
Shafazand S, Weinacker AB. Blood cultures in the Critical Care Unit. Improving Utilization and Yield. Chest 2002;122:1727-36.
Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19:788-802.
Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365-9.
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;137:791-7.
Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Nov A, Schwartz D, et al. Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis 2002;34:1431-9.
Coburn B, Morris AM, Tomlinson G, Detsky AS. Does This Adult Patient With Suspected Bacteremia Require Blood Cultures? JAMA 2012;308:502-11.
Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJ, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1373-1406.
3-Hour Bundle: Surviving Sepsis Campaign. http://www.survivingsepsis.org/SiteCollectionDocuments/Bundle-3-Hour-Sepsis-Step2-Blood-Cultures.pdf. Accessed Nov 15 2016.
Fuglsang-Damgaard D, Pedersen G, Schønheyder HC. Positive blood cultures and diagnosis of bacterial meningitis in cases with negative culture of cerebrospinal fluid. Scand J Infect Dis 2008;40:229-33.
Aronson MD, Bor DH. Diagnostic decision: Blood cultures. Ann Intern Med 1987;106:246-53.
O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Clin Infect Dis 2011;52:e162-93.
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;36:309–32.
Norton D. Calculating the risk: reflections on the Norton scale. Decubitus 1989;2:24-31.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987;40:373-83.
Leibovici L, Greenshtain S, Cohen O, Mor F, Wysenbeek AJ. Bacteremia in febrile patients. A clinical model for diagnosis. Arch Intern Med 1991;151:1801-6.
Souvenir D, Anderson DE, Palpant S, Mroch H, Askin S, Anderson J, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:1923-6.
Hartz AJ, Krakauer H, Kuhn EM, Young M, Jacobsen SJ, Gay G, et al. Hospital characteristics and mortality rates. New Engl J Med 1989;321:1720-5.
Wisplinghoff, H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309-17.
Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother 2004;48:4574-81.
Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol 2003;41:3655-60.
Lyytikäinen O, Ruotsalainen E, Järvinen A, Valtonen V, Ruutu P. Trends and outcome of nosocomial and community-acquired bloodstream infections due to Staphylococcus aureus in Finland, 1995–2001. Eur J Clin Microbiol Infect Dis 2005;24:399-404.
Pittet D, Tarara D, Wenzel RP. Nosocomial Bloodstream Infection in Critically III Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality. JAMA 1994;271:1598-1601.
de Kraker MEA, Wolkewitz M, Davey PG, Grundmann H, and BURDEN Study Group. The clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011; doi:10.1128/AAC.01157-10.
Huh K, Kim J, Cho SY, Ha YE, Joo EJ, Kang CI, et al. Continuous increase of the antimicrobial resistance among gram-negative pathogens causing bacteremia: a nationwide surveillance study by the Korean Network for Study on Infectious Diseases (KONSID). Diagn Micro Infect Dis 2013;76:477-82.
Fankhauser C, Schrenzel J, Francois P, Pittet D, Harbarth S. Secular trends of methicillin-resistant Staphylococcus aureus (MRSA) at Geneva University Hospitals (HUG) over a 14-year period. Antimicrob Resist Infect Control 2105;4:(S1) O9.
Pearson A, Chronias A, Murray M. Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother 2009;64(S1):i11-i17.
Falagas ME, Karageorgopoulos DE. Extended-spectrum beta-lactamase-producing organisms. J Hosp Infect 2009;73:345-54.
Bilavsky E, Temkin E, Lerman Y, Rabinovich A, Salomon J, Lawrence C, et al. Risk factors for colonization with extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae on admission to rehabilitation centres. Clin Micro Infect 2014;20:O804-10.
Gales AC, Castanheira M, Jones RN, Sader HS. Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008–2010). Diagn Microbiol Infect Dis 2012;73:354-60.
Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, et al. Antimicrobial-Resistant Pathogens Associated with Healthcare-Associated Infections Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol 2013;34:1-14.
Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996;23:40-6.
McGregor JC, Kim PW, Perencevich EN, Bradham DD, Furuno JP, Kaye KS, et al. Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005;161:483-93.
Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 1998;279:1187-93.
Justo D, Guy N, Halperin E, Lerman Y. Admission Norton scale scores are associated with long-term mortality following rehabilitation in older adults. J Rehabil Med 2012;44:172-5.
DOI: http://dx.doi.org/10.18103/imr.v3i6.476
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