title: Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study.
abstract: BACKGROUND
  Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area.
  
  
  METHODS
  A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006-2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression.
  
  
  RESULTS
  341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found.
  
  
  CONCLUSIONS
  HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.
authors.affiliation: Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain. pilaretamar@hotmail.com
authors.forename: Pilar
authors.initials: P
authors.lastname: Retamar
authors.forename: María Dolores
authors.initials: MD
authors.lastname: López-Prieto
authors.forename: Clara
authors.initials: C
authors.lastname: Nátera
authors.forename: Marina
authors.initials: M
authors.lastname: de Cueto
authors.forename: Enrique
authors.initials: E
authors.lastname: Nuño
authors.forename: Marta
authors.initials: M
authors.lastname: Herrero
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Sánchez
authors.forename: Angel
authors.initials: A
authors.lastname: Muñoz
authors.forename: Francisco
authors.initials: F
authors.lastname: Téllez
authors.forename: Berta
authors.initials: B
authors.lastname: Becerril
authors.forename: Ana
authors.initials: A
authors.lastname: García-Tapia
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Carazo
authors.forename: Raquel
authors.initials: R
authors.lastname: Moya
authors.forename: Juan E
authors.initials: JE
authors.lastname: Corzo
authors.forename: Laura
authors.initials: L
authors.lastname: León
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Muñoz
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-López
authors.forename: María V
authors.initials: MV
authors.lastname: García
authors.forename: Verónica
authors.initials: V
authors.lastname: Fernández-Galán
authors.forename: Alfonso
authors.initials: A
authors.lastname: del Arco
authors.forename: María J
authors.initials: MJ
authors.lastname: Pérez-Santos
authors.forename: Antonio
authors.initials: A
authors.lastname: Sánchez Porto
authors.forename: Manuel
authors.initials: M
authors.lastname: Torres-Tortosa
authors.forename: Andrés
authors.initials: A
authors.lastname: Martín-Aspas
authors.forename: Ascensión
authors.initials: A
authors.lastname: Arroyo
authors.forename: Carolina
authors.initials: C
authors.lastname: García-Figueras
authors.forename: Federico
authors.initials: F
authors.lastname: Acosta
authors.forename: Carmen
authors.initials: C
authors.lastname: Florez
authors.forename: Petra
authors.initials: P
authors.lastname: Navas
authors.forename: Trinidad
authors.initials: T
authors.lastname: Escobar-Lara
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents