title: Prevalence and risk factors for antibiotic-resistant community-associated bloodstream infections.
abstract: BACKGROUND
  Antibiotic resistance is increasing in many community settings. The purpose of this study was to determine the proportion of antibiotic resistant community-associated bloodstream infections (CA-BSIs) present on hospital admissions to identify risk factors for acquiring resistant versus susceptible CA-BSIs and to describe the incidence of concurrent infections with CA-BSIs.
  
  
  METHODS
  We conducted a retrospective cohort study of patients discharged from one community, one pediatric, and two tertiary/quaternary care hospitals within an academically affiliated network in the borough of Manhattan in New York, NY, from 2006 to 2008. The CA-BSIs present at hospital admission were defined as BSIs occurring within the first 48h of hospitalization. Infections and patient characteristics were identified using data available from patients' electronic medical records and discharge records.
  
  
  RESULTS
  In total, 1677 CA-BSIs were identified. Staphylococcus aureus had the largest proportion of resistance (41.2%), followed by enterococcal species (24.3%), Pseudomonas aeruginosa (20.2%), Streptococcus pneumoniae (16.6%), Acinetobacter baumannii (10.0%), and Klebsiella pneumoniae (9.9%). Significant predictors of resistance were prior residence in a skilled nursing facility (OR, 2.55; 95% CI, 1.39-4.70), advanced age (1.01; 1.002-1.02), presence of malignancy (0.58; 0.37-0.91), prior hospitalization (1.62; 1.17-2.23), a weighted Charlson score (1.09; 1.02-1.17) for S. aureus, presence of malignancy (1.82; 1.004-3.30), prior hospitalizations (2.03; 1.12-3.38) for enterococcal species, and younger age for S. pneumoniae (p=0.02). Urinary tract infections were the most common concurrent infection (n=45/87, 51.7%).
  
  
  CONCLUSIONS
  Over 27% of the CA-BSIs present on admission were antibiotic resistant. Understanding the prevalence and risk factors for CA-BSIs may help improve empiric antibiotic therapy and outcomes for patients with community-onset infections.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address: cmw2188@columbia.edu.
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Wolfe
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA; Columbia University School of Nursing, 630 West 168th Street, New York, NY 10032, USA. Electronic address: bac2116@columbia.edu.
authors.forename: Bevin
authors.initials: B
authors.lastname: Cohen
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA; Columbia University School of Nursing, 630 West 168th Street, New York, NY 10032, USA. Electronic address: ell23@columbia.edu.
authors.forename: Elaine
authors.initials: E
authors.lastname: Larson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009519:New York City; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Bloodstream infections; Community-associated bloodstream infections