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Bloodstream Infections in a Community Hospital: A 25-Year Follow-Up

Published online by Cambridge University Press:  02 January 2015

William E. Scheckler ,
James A. Bobula ,
Mark B. Beamsley  and
Scott T. Hadden
William E. Scheckler*
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
James A. Bobula
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
Mark B. Beamsley
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
Scott T. Hadden
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
*
University of Wisconsin, Department of Family Medicine, 777 South Mills Street, Madison, WI 53715
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Abstract

Objective:

To examine the current status of bloodstream infections (BSIs) in a community hospital as part of a 25-year longitudinal study.

Design:

Retrospective descriptive epidemiologic study.

Setting:

Community teaching hospital.

Patients:

All inpatients in 1998 with a positive blood culture who met the CDC NNIS System case definition of BSI.

Methods:

Cases were stratified by underlying illness category using case mix adjustment categories (after McCabe) and reviewed for associations among mortality, underlying illness severity, and multiple clinical and laboratory parameters.

Results:

Of 19,289 patients discharged in 1998,185 had an episode of infection documented by blood culture (96 cases per 10,000 inpatients). BSI was twice as frequent in patients 65 years and older compared with younger patients. BSIs caused or contributed to the deaths of 22 patients for an overall case-fatality rate of 11.9% compared with 20.7% in 1982 (P = .02). Striking decreases were noted for in-hospital patient mortality in 1998 for BSIs with ultimately and rapidly fatal underlying illnesses (P = .02 and P < .10, respectively). Primary bacteremia decreased compared with 1982. Antibiotic use was vigorous, but resistance was modest in both nosocomial and community-acquired organisms and had changed little from 1982 and 1987.

Conclusions:

Compared with previous studies, case-fatality rates in patients with BSI were substantially lower in rapidly fatal and ultimately fatal underlying illness categories. Antibiotic use was extensive but prompt and appropriate. Microorganism resistance to antibiotics changed little from the 1980s.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 936 - 941
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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References

1. Scheckler, WE. Septicemia in a community hospital, 1970 through 1973. JAMA 1977;237:1938–1941.10.1001/jama.1977.03270450028014Google Scholar
2. Scheckler, WE, Scheibel, W, Kresge, D. Temporal trends in septicemia in a community hospital. Am J Med 1991;91(suppl 3B):S3B90–S3B94.10.1016/0002-9343(91)90350-7Google Scholar
3. Burkert, T, Watanakunakorn, C. Group A streptococcal bacteremia in a community teaching hospital: 1980-1989. Clin Infect Dis 1992;14:29–37.10.1093/clinids/14.1.29Google Scholar
4. Watanakunakorn, C, Bailey, TA. Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. Arch Intern Med 1997;157:1965–1971.10.1001/archinte.1997.00440380069007Google Scholar
5. Cunney, RJ, McNamara, EB, AlAnsari, N, Smyth, EG. Community and hospital acquired Staphylococcus aureus septicaemia: 115 cases from a Dublin teaching hospital. J Infect 1996;33:11–13.10.1016/S0163-4453(96)92643-2Google Scholar
6. Watanakunakorn, C, Greifenstein, A, Stroh, K, et al. Pneumococcal bacteremia in three community teaching hospitals from 1980 to 1989. Chest 1993;103:1152–1156.10.1378/chest.103.4.1152Google Scholar
7. Peraino, VA, Cross, SA, Goldstein, EJC. Incidence and clinical significance of anaerobic bacteremia in a community hospital. Clin Infect Dis 1993;16(suppl 4):S288–S291.10.1093/clinids/16.Supplement_4.S288Google Scholar
8. Haug, JB, Harthug, S, Kalager, T, et al. Bloodstream infections at a Norwegian university hospital, 1974-1979 and 1988-1989: changing etiology, clinical features and outcome. Clin Infect Dis 1994;19:246–256.10.1093/clinids/19.2.246Google Scholar
9. Geerdes, HF, Ziegler, D, Lode, H, et al. Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989. Clin Infect Dis 1992;15:991–1002.10.1093/clind/15.6.991Google Scholar
10. Cockerill, FR, Hughes, JG, Vetter, EA, et al. Analysis of 281,797 consecutive blood cultures performed over an eight-year period: trends in microorganisms isolated and the value of anaerobic culture of blood. Clin Infect Dis 1997;24:403–418.10.1093/clinids/24.3.403Google Scholar
11. Gosbell, IB, Newton, PJ, Sullivan, EA. Survey of blood cultures from five community hospitals in south-western Sydney, Australia, 1993-94. Aust NZJ Med 1999;29:684–692.10.1111/j.1445-5994.1999.tb01616.xGoogle Scholar
12. Setia, U, Gross, PA. Bacteremia in a community hospital. Arch Intern Med 1977;137:1698–1701.10.1001/archinte.1977.03630240032012Google Scholar
13. Haddy, RI, Klimberg, S, Epting, RJ. A two-center review of bacteremia in the community hospital. J Fam Pract 1987;24:253–259.Google Scholar
14. Scheckler, WE. Continuous quality improvement in a community teaching hospital. Infect Control Hosp Epidemiol 1992;13:678–682.10.2307/30147011Google Scholar
15. Scheckler, WE. Continuous quality improvement in a hospital system: implications for hospital epidemiology. Infect Control Hosp Epidemiol 1992;13:288–292.10.2307/30145504Google Scholar
16. Gross, PA, Barrett, TL, Dellinger, EP, et al. Purpose of quality standards for infectious diseases: Infectious Diseases Society of America. Clin Infect Dis 1994;18:421.10.1093/clinids/18.3.421Google Scholar
17. Pinner, RW, Teutsch, SM, Simonsen, L, et al. Trends in infectious diseases mortality in the United States. JAMA 1996;275:189–193.10.1001/jama.1996.03530270029027Google Scholar
18. Schwartz, B, Bell, DM, Hughes, JM. Preventing the emergence of antimicrobial resistance: a call for action by clinicians, public health officials and patients. JAMA 1997;278:944–945.10.1001/jama.1997.03550110082041Google Scholar
19. Goldman, DA, Weinstein, RA, Wenzel, RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. JAMA 1996;275:234–240.10.1001/jama.1996.03530270074035Google Scholar
20. Alangaden, GJ, Lerner, SA. Overview of antimicrobial resistance: National Foundation for Infectious Diseases. Infectious Diseases 1997;4:1–4.Google Scholar
21. Centers for Disease Control and Prevention. Monitoring hospital-acquired infections to promote patient safety: United States, 1990-1999. MMWR 2000;49:149–153.Google Scholar
22. Baine, WB, Yu, W Sume, JP. The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998: application of Medicare claims data. Ann Epidemiol 2001;11:188–226.10.1016/S1047-2797(00)00184-8Google Scholar
23. Scheckler, WE, Brimhall, D, Buck, AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hosp Epidemiol 1998;19:114–124.10.2307/30142002Google Scholar