title: Risk factors for increased mortality from hospital-acquired versus community-acquired infections in febrile medical patients.
abstract: BACKGROUND
  Risk factors for hospital-acquired infection and attributable mortality in surgical and critically ill patients are well-known. We sought to identify factors associated with increased mortality from hospital-acquired infections as compared with community-acquired infections in patients with new-onset fever and a presumed infectious focus (n = 212), in a department of internal medicine.
  
  
  METHODS
  Demographic, clinical, and laboratory variables were studied for 2 days after inclusion. Septic shock and outcome were monitored for up to 7 and 28 days after inclusion, respectively.
  
  
  RESULTS
  Of the 212 patients, 54 had hospital-acquired and 158 community-acquired infection, with septic shock rates of 15% and 4% and mortality rates of 24% and 6% (P = .001), respectively. Prior neurologic disease was associated with death. Patients with hospital-acquired infection had more often (intravascular) devices and underwent more often interventions, had a different distribution of infectious foci, and had more often bacteremia. Bacteremia-associated septic shock was associated with nonsurvival in both infection groups. The causative agents were not associated with outcome, and the clinical and laboratory host response associated with nonsurvival generally did not differ among infection groups.
  
  
  CONCLUSIONS
  Our data suggest that hospital-acquired infections carry a higher crude mortality rate than community-acquired infection in febrile medical patients, mainly because of more frequent use of devices and hospital interventions and resultant bacteremia and septic shock, rather than by differences in underlying diseases, causative agents, and clinical and laboratory host responses. The observations thus emphasize the continued importance of preventive measures on medical wards of our hospital and can be used for comparison with future studies.
authors.affiliation: Vrije Universiteit Medical Centre and Institute for Cardiovascular Research at the Vrije Universiteit, Amsterdam, The Netherlands. johan.groeneveld@vumc.nl
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality*; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors