title: Bloodstream infections in adults: importance of healthcare-associated infections.
abstract: OBJECTIVE
  The objective of this study was to evaluate the characteristics of bloodstream infections occurring among outpatients having recent contact with the health care system compared to hospital and community-acquired infections.
  
  
  METHODS
  Prospective observational cohort study of adult patients with bloodstream infections at three teaching hospitals. Bloodstream infection was defined as hospital-acquired if the first positive blood culture was performed more than 48 h after admission. Other bloodstream infections were classified as healthcare-associated or community-acquired.
  
  
  RESULTS
  A total of 1157 episodes of bloodstream infections were studied; 581 (50.2%) were community-acquired, 295 (25.5%) were hospital-acquired, and 281 (24.3%) were health care-associated. Of the 281 health care-associated bloodstream infections, 68 (24%) occurred in patients residing in a nursing home, 104 (37%) in patients receiving intravenous therapy, health care at home, chemotherapy or attending dialysis, and 169 (60%) in patients hospitalized during the 90 days before their bloodstream infection (some patients belonged to more than one risk category). The highest prevalence rate of MRSA infections occurred in healthcare-associated infections (5%) (p<0.001). A significantly higher mortality rate was seen in the group with healthcare-associated infections (27.5%) than in community-acquired infections (10.4%) (p<0.001).
  
  
  CONCLUSIONS
  Our results confirm that healthcare-associated bloodstream infections show important differences from community-acquired bloodstream infections and suggest that empirical antibiotic therapy should be similar to hospital-acquired bloodstream infections, taking into account the epidemiologic characteristics of each region.
authors.affiliation: Critical Care Center, Hospital Sabadell, Institut Universitari Parc Taulí, 08208 Sabadell, Spain. jvalles@cspt.es
authors.forename: J
authors.initials: J
authors.lastname: Vallés
authors.forename: E
authors.initials: E
authors.lastname: Calbo
authors.forename: E
authors.initials: E
authors.lastname: Anoro
authors.forename: D
authors.initials: D
authors.lastname: Fontanals
authors.forename: M
authors.initials: M
authors.lastname: Xercavins
authors.forename: E
authors.initials: E
authors.lastname: Espejo
authors.forename: G
authors.initials: G
authors.lastname: Serrate
authors.forename: N
authors.initials: N
authors.lastname: Freixas
authors.forename: M A
authors.initials: MA
authors.lastname: Morera
authors.forename: B
authors.initials: B
authors.lastname: Font
authors.forename: F
authors.initials: F
authors.lastname: Bella
authors.forename: F
authors.initials: F
authors.lastname: Segura
authors.forename: J
authors.initials: J
authors.lastname: Garau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology*; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D016469:Fungemia / Q000453:epidemiology*; D006437:Hemodialysis, Home; D006784:Hospitals, Teaching; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008875:Middle Aged; D009735:Nursing Homes; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology