title: [Clinical and microbiological analysis of community-acquired bacteremia admitted to a tertiary teaching hospital].
abstract: OBJECTIVE
  To investigate clinical and microbiological characteristics of community-acquired bacteremia (CAB).
  
  
  METHODS
  We retrospectively analyzed subjects with CAB hospitalized at Saga University Hospital between January 2009 and September 2011. We investigated causative organisms, primary infection sites, and subject summaries and complications, and analyzed the mortality factor.
  
  
  RESULTS
  CAB incidence was 185 cases, with 192 organisms cultured. Causative organisms were gram-positive bacteria in 81 strains (42%), 9 (11%) of which were methicillin-resistant Staphylococcus aureus (MRSA). Gram-negative bacteria were identified in 111 strains (58%), with 80% Enterobacteriaceae. Five of the 111 (5%) were caused by extended-spectrum beta-lactamase (ESBL) producing bacteria. The most frequent bacteremia portal was intraabdominal infection (29%, 54/185). During hospitalization of 1-180 days, 20 subjects eventually died. Neutropenia on admission was associated with significantly higher mortality than without (30% vs. 3%, p < 0.001). Septic shock rates were higher in non-survivors than survivors (45% vs. 14%, p = 0.002), and more complications were documented in non-survivors than survivors (50% vs. 25%, p = 0.017). No specific pathogen or primary infection site was associated with higher mortality.
  
  
  CONCLUSIONS
  Antimicrobial-resistant pathogens such as MRSA and ESBL producers should be considered even in CAB, especially in subjects with healthcare-associated infection, regardless of how small the number. The CAB treatment course should consider subjects summaries, severity, and complications.
authors.affiliation: Intensive Care Unit, Saga University Hospital.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yamada
authors.forename: Yohei
authors.initials: Y
authors.lastname: Hamada
authors.forename: Hiroki
authors.initials: H
authors.lastname: Magaribuchi
authors.forename: Masaki
authors.initials: M
authors.lastname: Nagata
authors.forename: Mami
authors.initials: M
authors.lastname: Fukuoka
authors.forename: Koji
authors.initials: K
authors.lastname: Kusaba
authors.forename: Zenzo
authors.initials: Z
authors.lastname: Nagasawa
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Aoki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents