title: Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients.
abstract: OBJECTIVE
  Nosocomial infections are a large burden to both patients and health care organizations, causing hospitals to take measures in an attempt to reduce microorganism transmission. Patients treated by emergency medical services are one population that has not been studied regarding infection rates. This study examines admitted patients treated by advanced life support (ALS) and their likelihood of having community-acquired and nosocomial infections.
  
  
  METHODS
  A retrospective cohort study was conducted of 154 318 admitted patients between 2003 and 2007. Subjects identified as having either community-acquired or nosocomial infections were grouped based on infection type and ALS treatment. The proportion of infected patients among total hospital admissions in each of these groups was calculated and compared using odds ratios (ORs).
  
  
  RESULTS
  A total of 5418 patients had at least 1 infection while admitted (3653 nosocomial, 1765 community). The probability of an ALS patient getting a nosocomial infection was 3.20% versus 2.28% for non-ALS patients (OR, 1.42; 95% confidence interval [CI], 1.28-1.57). There was no significant difference in community-acquired infections between ALS and non-ALS-treated groups (1.22% vs 1.14%; OR, 1.08; 95% CI, 0.92-1.26).
  
  
  CONCLUSIONS
  Despite having similar rates of community-acquired infections, patients admitted after ALS treatment had significantly greater risk for nosocomial infections. Because causality is not established, it remains unknown whether paramedic interventions contributed to the increased rate. Quite possibly, these patients are more susceptible to virulent organisms; however, prospective research is needed to identify causal relationships. Thus, treatment by ALS can be used as an identifier of patients at an increased risk of acquiring nosocomial infections.
authors.affiliation: Department of Medical Education, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, 08854, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Alter
authors.forename: Mark A
authors.initials: MA
authors.lastname: Merlin
mesh_terms: D022561:Advanced Cardiac Life Support / Q000009:adverse effects / Q000706:statistics & numerical data*; D000368:Aged; D017714:Community-Acquired Infections / Q000453:epidemiology*; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies