title: Four-year prospective evaluation of community-acquired bacteremia: epidemiology, microbiology, and patient outcome.
abstract: The objectives of this study were to (1) describe the epidemiology and microbiology of community-acquired bacteremia; (2) determine the crude mortality associated with such infections; and (3) identify independent predictors of mortality. All patients with clinically significant community-acquired bacteremia admitted to a university-affiliated Veterans Affairs medical center from January 1994 through December 1997 were evaluated. During the study period, 387 bacteremic episodes occurred in 334 patients. Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococci were the most commonly isolated organisms; the most frequent sources were the urinary tract and intravascular catheters. Approximately 14% of patients died. Patient characteristics independently associated with increased mortality included shock (OR 3.7, p = 0.02) and renal failure (OR 4.0, p = 0.003). The risk of death was also higher in those whose source was pneumonia (OR 6.3, p = 0.03) or an intra-abdominal site (OR 10.7, p = 0.02), or if multiple sources were identified (OR 13.4, p = 0.003). Community-acquired bacteremia is often device-related and may be preventable. Strategies that have been successful in preventing nosocomial device-related bacteremia should be adapted to the outpatient setting.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, and Department of Control and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Lark
authors.forename: S
authors.initials: S
authors.lastname: Saint
authors.forename: C
authors.initials: C
authors.lastname: Chenoweth
authors.forename: J K
authors.initials: JK
authors.lastname: Zemencuk
authors.forename: B A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: J J
authors.initials: JJ
authors.lastname: Plorde
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D002404:Catheterization; D002408:Catheters, Indwelling; D017714:Community-Acquired Infections; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis