title: Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia.
abstract: In recent years, dramatic changes in health care systems have shifted much of the care of sick individuals from hospitals to the community. Consequently, infections traditionally classified as community-acquired or hospital-acquired infections cannot now be readily classified into either category. We thus propose a new classification based on a wider spectrum of acquisition. A total of 1028 episodes of bloodstream infection (BSI) were divided into 5 categories: true community-acquired infections (370 episodes [36%]), infections in recently discharged patients (110 [11%]), infections associated with invasive procedures performed just before or at the time of admission (56 [5%]), infections in patients admitted from nursing homes (68 [7%]), and hospital-acquired infections (424 [41%]). Thus, 234 (39%) of the 604 bloodstream infections traditionally defined as community acquired were reclassified into 3 newly defined groups, each of which has distinct epidemiologic, clinical, and bacteriologic characteristics, as well as distinct antimicrobial susceptibility profiles. There is a conceptual and practical need for such a new classification.
authors.affiliation: Infectious Diseases Unit, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel. ZIHUM@tasmc.health.gov.il
authors.forename: Yardena
authors.initials: Y
authors.lastname: Siegman-Igra
authors.forename: Boaz
authors.initials: B
authors.lastname: Fourer
authors.forename: Ruth
authors.initials: R
authors.lastname: Orni-Wasserlauf
authors.forename: Yoav
authors.initials: Y
authors.lastname: Golan
authors.forename: Aliza
authors.initials: A
authors.lastname: Noy
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Michael
authors.initials: M
authors.lastname: Giladi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000145:classification* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D004926:Escherichia coli / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D013211:Staphylococcus aureus / Q000187:drug effects; D013296:Streptococcus pneumoniae / Q000187:drug effects