title: Bloodstream infections in a secondary and tertiary care hospital setting.
abstract: BACKGROUND
  Bloodstream infections (BSI) occurring in community and health-care settings vary with the patient group and treatment of underlying medical conditions. We studied the clinical infectious syndromes occurring in patients with positive blood cultures routinely obtained at a regional secondary and tertiary care hospital.
  
  
  METHODS
  BSI were categorized as either community-acquired (C-BSI), or health-care-associated (H-BSI) acquired either as a (i) non-inpatient (outpatient) or (ii) hospital inpatient. Clinical information was collected prospectively during the 1-year study.
  
  
  RESULTS
  There were 193 C-BSI and 230 H-BSI. The large majority of C-BSI were caused by bacterial pathogens susceptible to narrow-spectrum antibiotics, particularly in children. Cefuroxime was active against 90% of C-BSI isolates and 46% of H-BSI isolates, excluding anaerobes. Of all H-BSI, the 35% occurring in outpatients had a similar source, microbiological cause and bacterial susceptibilities to the inpatients. H-BSI were infrequently due to enterococci (4%), Candida (3%) or methicillin-resistant Staphylococcus aureus (0.4%). No BSI were due to vancomycin-resistant enterococci or extended-spectrum beta-lactamase producing Enterobacteriaciae. I.v. catheters, predominantly central lines, were the source of 60% of all H-BSI, mostly in haematology-oncology or neonatal patients. Mortality at 1 month was 12% overall for both C-BSI and H-BSI, varying markedly by underlying disease and increasing age (for C-BSI).
  
  
  CONCLUSIONS
  In this population, C-BSI have remained susceptible to narrow-spectrum antibiotics, whereas H-BSI due to multiresistant organisms were rare. Obtaining a history of recent medical procedures is important for community patients presenting with a BSI.
authors.affiliation: Department of Internal Medicine, Infectious Disease Serevice, Wellington Hospital, Wellington, New Zealand. nigel.raymond@ccdhb.org.nz
authors.forename: N J
authors.initials: NJ
authors.lastname: Raymond
authors.forename: T K
authors.initials: TK
authors.lastname: Blackmore
authors.forename: M W
authors.initials: MW
authors.lastname: Humble
authors.forename: M R
authors.initials: MR
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D016469:Fungemia / Q000453:epidemiology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies