Epidemiology of bacteremia episodes in a single center: increase in Gram-negative isolates, antibiotics resistance, and patient age.
Increased resistance among isolates causing bacteremia constitutes a major challenge to medical practitioners and institutions. Variability between institutes is substantial, and requires the individual analysis of local trends. An eight-year (1997-2004) surveillance study of episodes of bacteremia was conducted in an 850-bed university hospital in central Israel. Trends of incidence, resistance, age, and mortality were analyzed. We studied 6,096 patient-unique episodes of bacteremia, of which, 2,722 (45.3%) were nosocomial and 523 (9.2%) involved children less than 18 years of age. The overall incidence of bacteremia episodes has increased over the study years by 39% and the patient mean age by 7.5 years. Gram-negative organisms accounted for 72% of hospital-acquired cases and 69% of community-acquired cases. There was a substantial increase in the incidence of nosocomial episodes, predominantly due to Gram-negative isolates, mainly Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Increased resistance to broad-spectrum antibiotics was noted among Gram-negative organisms, including quinolones (in K. pneumoniae), imipenem (A. baumannii and P. aeruginosa), piperacillin-tazobactam (K. pneumoniae), and amikacin (A. baumannii and P. aeruginosa). Increased resistance to oxacillin among coagulase-negative staphylococci was also noted. The all-cause mortality rates showed a significant rise. The patient age, intensive care unit (ICU) stay, and hospital acquisition were independently associated with mortality. We describe an increase in the incidence and resistance of Gram-negative organisms causing bacteremia and concomitant ageing of the patients with bacteremia. Similar patterns have been reported from other localities, and are of real concern.
Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
D
D
Marchaim
R
R
Zaidenstein
T
T
Lazarovitch
Y
Y
Karpuch
T
T
Ziv
M
M
Weinberger
D000046:Academic Medical Centers; D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male
D000900:Anti-Bacterial Agents