title: Health-care-associated bloodstream infections at admission to the ICU.
abstract: BACKGROUND
  Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU.
  
  
  METHODS
  This work was a multicenter, prospective, observational study of all adult patients with BSI at ICU admission at 27 Spanish hospitals and one Argentine hospital. Cases of BSI were classified as community-acquired BSI (CAB), health-care-associated BSI (HCAB), or hospital-acquired BSI (HAB), and their characteristics were compared.
  
  
  RESULTS
  Of 726 BSIs, 343 (47.2%) were CABs, 252 (34.7%) were HABs, and 131 (18.0%) were HCABs. Potentially antibiotic-resistant pathogens were more frequently isolated in HABs (34.8%) and HCABs (27.6%) than in CABs (10.3%) (P < .001). Logistic regression analysis revealed that HABs (OR, 4.6; 95% CI, 2.9-7.3), HCABs (OR, 3.1; 95% CI, 1.8-5.4), and BSIs of unknown origin (OR, 1.7; 95% CI, 1.0-2.8) were independently associated with the isolation of potentially antibiotic-resistant pathogens. The incidence of inappropriate treatment was significantly higher in HABs (OR, 3.4; 95% CI, 2.1-5.3) and in HCABs (OR, 1.8; 95% CI, 1.0-3.2) than in CABs.
  
  
  CONCLUSIONS
  One in five BSIs diagnosed at ICU admission is health-care-associated. The incidence of potentially drug-resistant pathogens in HCABs is more similar to that of HABs, and they should be treated as such until culture data are available.
authors.affiliation: CIBER Enfermedades Respiratorias, Hospital Sabadell, Sabadell, Spain. Electronic address: jvalles@tauli.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.affiliation: Hospital del Mar, Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Palomar
authors.affiliation: Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: Blanco
authors.affiliation: Hospital Virgen del Rocío, Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Escoresca
authors.affiliation: Hospital Germans Trías i Pujol, Badalona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Armestar
authors.affiliation: Hospital Josep Trueta, Girona, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Sirvent
authors.affiliation: Hospital Interzonal General de Agudos "José de San Martín", La Plata, Argentina.
authors.forename: Carina
authors.initials: C
authors.lastname: Balasini
authors.affiliation: Hospital Peset, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zaragoza
authors.affiliation: Hospital Valme, Sevilla, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Marín
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology