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No Specific Time Window Distinguishes between Community-, Healthcare-, and Hospital-Acquired Bacteremia, but They Are Prognostically Robust

Published online by Cambridge University Press:  10 May 2016

Kim Oren Gradel ,
Stig Lønberg Nielsen ,
Court Pedersen ,
Jenny Dahl Knudsen ,
Christian Østergaard ,
Magnus Arpi ,
Thøger Gorm Jensen ,
Hans Jørn Kolmos ,
Henrik Carl Schønheyder  and
Mette Søgaard
...Show all authors
Kim Oren Gradel*
Affiliation:
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
Stig Lønberg Nielsen
Affiliation:
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
Court Pedersen
Affiliation:
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
Jenny Dahl Knudsen
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
Christian Østergaard
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
Magnus Arpi
Affiliation:
Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
Thøger Gorm Jensen
Affiliation:
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
Hans Jørn Kolmos
Affiliation:
Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
Henrik Carl Schønheyder
Affiliation:
Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; and Department of Clinical Medicine, Aalborg University, Aalborg Denmark
Mette Søgaard
Affiliation:
Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
Annmarie Touborg Lassen
Affiliation:
Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
for the Danish Collaborative Bacteraemi a Network and the Danish Observational Registry of Infectious Sndromes
Affiliation:
Center for Clinical Epidemiology, South, Odense University Hospital, and Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
*
Center for Clinical Epidemiology, Odense University Hospital, Sønder Boulevard 29, Entrance 101, 4th Floor, DK-5000 Odense C, Denmark (kim.gradel@rsyd.dk).
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Abstract

Objective.

We examined whether specific time windows after hospital admission reflected a sharp transition between community and hospital acquisition of bacteremia. We further examined whether different time windows to distinguish between community acquisition, healthcare association (HCA), and hospital acquisition influenced the results of prognostic models.

Design.

Population-based cohort study.

Setting.

Hospitals in 3 areas of Denmark (2.3 million inhabitants) during 2000–2011.

Methods.

We computed graphs depicting proportions of males, absence of comorbidity, microorganisms, and 30-day mortality pertaining to bacteremia 0, 1, 2, …, 30, and 31 days and later after admission. Next, we assessed whether different admission (0–1, 0–2, 0–3, 0–7 days) and HCA (30, 90 days) time windows were associated with changes in odds ratio (OR) and area under the receiver operating characteristic (ROC) curve for 30-day mortality, adjusting for sex, age, comorbidity, and microorganisms.

Results.

For 56,606 bacteremic episodes, no sharp transitions were detected on a specific day after admission. Among the 8 combined time windows, ORs for 30-day mortality varied from 1.30 (95% confidence interval [CI], 1.23–1.37) to 1.99 (95% CI, 1.48–2.67) for HCA and from 1.36 (95% CI, 1.24–1.50) to 2.53 (95% CI, 2.01–3.20) for hospital acquisition compared with community acquisition. Area under the ROC curve changed marginally from 0.684 (95% CI, 0.679–0.689) to 0.700 (95% CI, 0.695–0.705).

Conclusions.

No time transitions unanimously distinguished between community and hospital acquisition with regard to sex, comorbidity, or microorganisms, and no difference in 30-day mortality was seen for HCA patients in relation to a 30- or 90-day time window. ORs decreased consistently in the order of hospital acquisition, HCA, and community acquisition, regardless of time window combination, and differences in area under the ROC curve were immaterial.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 12 , December 2014 , pp. 1474 - 1482
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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