title: Unique characteristics of community-onset healthcare- associated bloodstream infections: a multi-centre prospective surveillance study of bloodstream infections in Japan.
abstract: BACKGROUND
  Analysis of bloodstream infections (BSIs) is valuable for their diagnosis, treatment and prevention. However, limited data are available in Japan.
  
  
  OBJECTIVE
  To investigate the characteristics of patients with bacteraemia in Japan.
  
  
  METHODS
  This study was conducted in five hospitals from October 2012 to September 2013. Clinical, demographic, microbiological and outcome data for all blood-culture-positive cases were analysed.
  
  
  RESULTS
  In total, 3206 cases of BSI were analysed: 551 community-onset healthcare-associated (CHA)-BSIs, 1891 hospital-acquired (HA)-BSIs and 764 community-acquired (CA)-BSIs. The seven- and 30-day mortality rates were higher in patients with CHA- and HA-BSIs than in patients with CA-BSIs. The odds ratios (ORs) for seven-day mortality were 2.56 [95% confidence interval (CI) 1.48-4.41] and 2.63 (95% CI 1.64-4.19) for CHA- and HA-BSIs, respectively. The ORs for 30-day mortality were 2.41 (95% CI 1.63-3.57) and 3.31 (95% CI 2.39-4.59) for CHA- and HA-BSIs, respectively. There were 499 cases (15.2%) of central-line-associated BSI and 163 cases (5.0%) of peripheral-line-associated BSI. Major pathogens included coagulase-negative staphylococci (N = 736, 23.0%), Escherichia coli (N = 581, 18.1%), Staphylococcus aureus (N = 294, 9.2%) and Klebsiella pneumoniae (N = 263, 8.2%). E. coli exhibited a higher 30-day mortality rate among patients with HA-BSIs (22.3%) compared with patients with CHA-BSIs (12.3%) and CA-BSIs (3.4%). K. pneumoniae exhibited higher 30-day mortality rates in patients with HA-BSIs (22.0%) and CHA-BSIs (22.7%) compared with patients with CA-BSIs (7.8%).
  
  
  CONCLUSIONS
  CHA- and HA-BSIs had higher mortality rates than CA-BSIs. The prognoses of E. coli- and K. pneumonia-related BSIs differed according to the category of bacteraemia.
authors.affiliation: Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Takeshita
authors.affiliation: Division of Infectious Diseases, Shizuoka Cancer Centre Hospital, Shizuoka, Japan.
authors.forename: I
authors.initials: I
authors.lastname: Kawamura
authors.affiliation: Division of Infectious Diseases, Shizuoka Cancer Centre Hospital, Shizuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kurai
authors.affiliation: Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Araoka
authors.affiliation: Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yoneyama
authors.affiliation: Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Infectious Diseases, National Hospital Organization, Hokkaido Cancer Centre, Hokkaido, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.affiliation: Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Infectious Diseases, Tokyo Metropolitan Health and Medical Treatment Corporation, Ebara Hospital, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ainoda
authors.affiliation: Department of Infectious Diseases, Kameda Medical Centre, Chiba, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Hase
authors.affiliation: Department of Infectious Diseases, Kameda Medical Centre, Chiba, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Hosokawa
authors.affiliation: Centre for Clinical Science, National Centre for Global Health and Medicine, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shimanuki
authors.affiliation: Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Centre, Komagome Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Sekiya
authors.affiliation: Disease Control and Prevention Centre, National Centre for Global Health and Medicine, Tokyo, Japan. Electronic address: lukenorioom@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Ohmagari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D017848:Blood-Borne Pathogens / Q000187:drug effects / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification
keywords: Bacteraemia; Community-acquired; Community-onset healthcare-associated; Healthcare-acquired; Japan; Mortality