title: Early deaths in bloodstream infections: a population-based case series.
abstract: A notable portion of deaths in bloodstream infections (BSI) have previously been shown to occur within 2 days after taking the first positive blood culture specimen. The aim of this study was to analyse patients' characteristics and causative pathogens of BSIs, leading to early deaths in order to explore possibilities for prevention. Patients with BSI in Helsinki and Uusimaa region (population = 1.5 million) in 2007 were identified from the National Infectious Disease Register (n = 2181) and their deaths within 2 days after the first positive blood culture from the Population Information System (n = 76). Of the early fatal BSIs, 42 (55%) were community-acquired (CA-BSI) and 34 (45%) healthcare-associated (HA-BSI). Charlson comorbidity index was moderate-to-high (index ≥ 3) in 71% of HA-BSIs and 60% of CA-BSIs. The most common pathogens in CA-BSIs were Streptococcus pneumoniae (29%) and Escherichia coli (24%) and in HA-BSIs Pseudomonas aeruginosa (24%) and Staphylococcus aureus (18%). The respiratory tract (50%) was the most common focus of infection. Empiric antimicrobial treatment was more often appropriate in CA-BSIs vs HA-BSIs (81% vs 41%, p < 0.001), but treatment delays were longer in CA-BSIs. The majority of the BSI patients who died early had severe comorbidities. S. pneumoniae accounted for one third of CA-BSIs, highlighting the potential role of pneumococcal vaccines in prevention. Early recognition of BSI and its origin (CA-BSI vs HA-BSI) is crucial. Continuous surveillance data on causative microbes and resistance trends in hospitals is needed to propose guidelines for empiric antimicrobial therapy of BSIs.
authors.affiliation: a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Keiju S K
authors.initials: KS
authors.lastname: Kontula
authors.affiliation: a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Kirsi
authors.initials: K
authors.lastname: Skogberg
authors.affiliation: b Department of Infectious Disease , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Ollgren
authors.affiliation: a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Asko
authors.initials: A
authors.lastname: Järvinen
authors.affiliation: b Department of Infectious Disease , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bloodstream infection; community-acquired; early death; healthcare-associated