Unique characteristics of community-onset healthcare-associated bloodstream infections: a multi-centre prospective surveillance study of bloodstream infections in Japan

被引：30
作者：
Takeshita, N. [1 ]
Kawamura, I. [2 ]
Kurai, H. [2 ]
Araoka, H. [3 ]
Yoneyama, A. [3 ]
Fujita, T. [4 ,8 ]
Ainoda, Y. [4 ,9 ]
Hase, R. [5 ]
Hosokawa, N. [5 ]
Shimanuki, H. [6 ]
Sekiya, N. [7 ]
Ohmagari, N. [1 ]
机构：
[1] Natl Ctr Global Hlth & Med, Dis Control & Prevent Ctr, Tokyo, Japan
[2] Shizuoka Canc Ctr Hosp, Div Infect Dis, Shizuoka, Japan
[3] Toranomon Gen Hosp, Dept Infect Dis, Tokyo, Japan
[4] Tokyo Womens Med Univ, Dept Infect Dis, Tokyo, Japan
[5] Kameda Med Ctr, Dept Infect Dis, Chiba, Japan
[6] Natl Ctr Global Hlth & Med, Ctr Clin Sci, Tokyo, Japan
[7] Komagome Hosp, Tokyo Metropolitan Canc & Infect Dis Ctr, Dept Clin Lab, Tokyo, Japan
[8] Natl Hosp Org, Hokkaido Canc Ctr, Dept Infect Dis, Sapporo, Hokkaido, Japan
[9] Ebara Hosp, Tokyo Metropolitan Hlth & Med Treatment Corp, Dept Infect Dis, Tokyo, Japan
来源：
JOURNAL OF HOSPITAL INFECTION | 2017年 / 96卷 / 01期
关键词：
Bacteraemia; Community-acquired; Healthcare-acquired; Community-onset healthcare-associated; Mortality; Japan; DEFINITION; BACTEREMIA; MORTALITY; OUTCOMES; LENGTH; STAY;
D O I：
10.1016/j.jhin.2017.02.022
中图分类号：
R1 [预防医学、卫生学];
学科分类号：
1004 ; 120402 ;
摘要：
Background: Analysis of bloodstream infections (BSIs) is valuable for their diagnosis, treatment and prevention. However, limited data are available in Japan. Aim: To investigate the characteristics of patients with bacteraemia in Japan. Methods: This study was conducted in five hospitals from October 2012 to September 2013. Clinical, demographic, microbiological and outcome data for all blood-culturepositive cases were analysed. Findings: In total, 3206 cases of BSI were analysed: 551 community-onset healthcareassociated (CHA)-BSIs, 1891 hospital-acquired (HA)-BSIs and 764 community-acquired (CA)-BSIs. The seven-and 30-day mortality rates were higher in patients with CHA-and HA-BSIs than in patients with CA-BSIs. The odds ratios (ORs) for seven-day mortality were 2.56 [95% confidence interval (CI) 1.48-4.41] and 2.63 (95% CI 1.64-4.19) for CHA-and HABSIs, respectively. The ORs for 30-day mortality were 2.41 (95% CI 1.63-3.57) and 3.31 (95% CI 2.39-4.59) for CHA-and HA-BSIs, respectively. There were 499 cases (15.2%) of central-line-associated BSI and 163 cases (5.0%) of peripheral-line-associated BSI. Major pathogens included coagulase-negative staphylococci (N = 736, 23.0%), Escherichia coli (N = 581, 18.1%), Staphylococcus aureus (N = 294, 9.2%) and Klebsiella pneumoniae (N = 263, 8.2%). E. coli exhibited a higher 30-day mortality rate among patients with HABSIs (22.3%) compared with patients with CHA-BSIs (12.3%) and CA-BSIs (3.4%). K. pneumoniae exhibited higher 30-day mortality rates in patients with HA-BSIs (22.0%) and CHA-BSIs (22.7%) compared with patients with CA-BSIs (7.8%). Conclusion: CHA-and HA-BSIs had higher mortality rates than CA-BSIs. The prognoses of E. coli-and K. pneumonia-related BSIs differed according to the category of bacteraemia. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society.
引用
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页码：29 / 34
页数：6
相关论文
共 11 条
[1]   The relationship between antimicrobial resistance and patient outcomes: Mortality, length of hospital stay, and health care costs [J].
Cosgrove, SE .
CLINICAL INFECTIOUS DISEASES, 2006, 42 :S82-S89
[2]   Epidemiology and outcome of nosocomial and community-onset bloodstream infection [J].
Diekema, DJ ;
Beekmann, SE ;
Chapin, KC ;
Morel, KA ;
Munson, E ;
Doern, GV .
JOURNAL OF CLINICAL MICROBIOLOGY, 2003, 41 (08) :3655-3660
[3]   Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections [J].
Friedman, ND ;
Kaye, KS ;
Stout, JE ;
McGarry, SA ;
Trivette, SL ;
Briggs, JP ;
Lamm, W ;
Clark, C ;
MacFarquhar, J ;
Walton, AL ;
Reller, LB ;
Sexton, DJ .
ANNALS OF INTERNAL MEDICINE, 2002, 137 (10) :791-797
[4]   Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe [J].
Goto, M. ;
Al-Hasan, M. N. .
CLINICAL MICROBIOLOGY AND INFECTION, 2013, 19 (06) :501-509
[5]   Japan: Universal Health Care at 50 years 3 Cost containment and quality of care in Japan: is there a trade-off? [J].
Hashimoto, Hideki ;
Ikegami, Naoki ;
Shibuya, Kenji ;
Izumida, Nobuyuki ;
Noguchi, Haruko ;
Yasunaga, Hideo ;
Miyata, Hiroaki ;
Acuin, Jose M. ;
Reich, Michael R. .
LANCET, 2011, 378 (9797) :1174-1182
[6]   CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting [J].
Horan, Teresa C. ;
Andrus, Mary ;
Dudeck, Margaret A. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2008, 36 (05) :309-332
[7]   Use of maximal sterile barriers during central venous catheter insertion: Clinical and economic outcomes [J].
Hu, KK ;
Veenstra, DL ;
Lipsky, BA ;
Saint, S .
CLINICAL INFECTIOUS DISEASES, 2004, 39 (10) :1441-1445
[8]   The distinct category of healthcare associated bloodstream infections [J].
Lenz, Ryan ;
Leal, Jenine R. ;
Church, Deirdre L. ;
Gregson, Daniel B. ;
Ross, Terry ;
Laupland, Kevin B. .
BMC INFECTIOUS DISEASES, 2012, 12
[9]   Reappraisal of community-acquired bacteremia: A proposal of a new classification for the spectrum of acquisition of bacteremia [J].
Siegman-Igra, Y ;
Fourer, B ;
Orni-Wasserlauf, R ;
Golan, Y ;
Noy, A ;
Schwartz, D ;
Giladi, M .
CLINICAL INFECTIOUS DISEASES, 2002, 34 (11) :1431-1439
[10]   Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals [J].
Son, Jun Seong ;
Song, Jae-Hoon ;
Ko, Kwan Soo ;
Yeom, Joon Sup ;
Ki, Hyun Kyun ;
Kim, Shin-Woo ;
Chang, Hyun-Ha ;
Ryu, Seong Yeol ;
Kim, Yeon-Sook ;
Jung, Sook-In ;
Shin, Sang Yop ;
Oh, Hee Bok ;
Lee, Yeong Seon ;
Chung, Doo Ryeon ;
Lee, Nam Yong ;
Peck, Kyong Ran .
JOURNAL OF KOREAN MEDICAL SCIENCE, 2010, 25 (07) :992-998
12