Most Bloodstream Infections Are Community-Onset

Thirty-eight percent of patients receive inappropriate empiric antimicrobial therapy.
Thirty-eight percent of patients receive inappropriate empiric antimicrobial therapy.

Most bloodstream infections (BSIs) are community-onset and health care-associated, and Staphylococcus aureus is the most common pathogen, according to a study published online in PLOS ONE.

Deverick J. Anderson, MD, MPH, of Duke University Medical Center in Durham, N.C., and colleagues conducted a multicenter cohort study to describe the epidemiology of BSIs and determine risk factors for inappropriate therapy. From 2003 through 2006, 1,470 patients were identified as having a BSI in nine community hospitals in the southeastern United States.

The researchers found that 56% of BSIs were community-onset, healthcare-associated; 29% of patients had community-acquired BSIs, and 15% had hospital-onset, health care-associated BSIs. In 23% of cases, the BSIs were due to multidrug-resistant pathogens.

The type of infecting organism varied by location of acquisition, with the most common pathogens being Staphylococcus aureus (28%), Escherichia coli (24%), and coagulase-negative staphylococci (10%). Results also showed that 38% of patients were given inappropriate empiric antimicrobial therapy, with the proportion varying by hospital from 21%-71% (median, 33%).

Factors independently linked to failure to receive appropriate empiric antimicrobial therapy included hospital providing care, assistance with three or more activities of daily living, Charlson score, community-onset, and hospital-onset health care-associated infection.

"Our data suggest that appropriateness of empiric antimicrobial therapy is an important and needed performance metric for physicians and hospital stewardship programs in community hospitals," the authors wrote.

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