title: Hospital-acquired Staphylococcus aureus primary bloodstream infection: A comparison of events that do and do not meet the central line-associated bloodstream infection definition.
abstract: This study was done to describe the incidence and outcomes of primary hospital-acquired bloodstream infection (HABSI) secondary to Staphylococcus aureus (SA) that did and did not meet the National Healthcare Safety Network's (NHSN's) definition for central line-associated bloodstream infection (CLABSI).
  
  
  
  Consecutive hospitalized patients during a 48-month study period with an SA HABSI were categorized according to those who did and did not meet the NHSN's definitions for CLABSI and non-CLABSI. Primary outcomes were mortality at 30 days and 1 year. Secondary outcomes were the incidence of complicated bacteremia and the need for operative intervention secondary to the HABSI event.
  
  
  
  A total of 122 episodes of primary SA HABSIs were identified: 78 (64%) were CLABSIs, and 44 (36%) were non-CLABSIs. Overall 30-day and 1-year mortality in the cohort was 21.3% and 38.5%, respectively, and did not differ significantly between the 2 groups. Complicated SA HABSI was significantly more common in the non-CLABSI group (15.9% [n = 7] vs 0% [n = 0], P ≤ .001).
  
  
  
  Primary SA HABSI was associated with significant 30-day and 1-year mortality. Complications from SA non-CLABSI requiring surgical intervention were significantly more common than in those with a CLABSI event. Our findings affirm the significance of non-device-related hospital-acquired infections.
authors.affiliation: Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kovacsc@ccf.org.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: Department of Infection Prevention, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fatica
authors.affiliation: Department of Qualitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Robert
authors.initials: R
authors.lastname: Butler
authors.affiliation: Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
authors.affiliation: Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, OH; Department of Infection Prevention, Quality and Patient Safety Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Fraser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016019:Survival Analysis
keywords: Staphylococcus aureus; central line–associated bloodstream infection; health care–associated bloodstream infection; infection surveillance; primary bacteremia