Similar articles

Abstract: In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

医院获得性血流感染的流行病学和病原学特征分析：482例感染病例的回顾性调查

[1]Bone, R.C., Balk, R.A., Cerra, F.B., et al., 1992. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med., 20(6):864-874.

[2]Clinical and Laboratory Standards Institute, 2007. Performance Standards for Antimicrobial Susceptibility Testing: 17th Informational Supplement. Vol. 27, No. 1, M100-S17, CLSI, Wayne, PA, USA.

[3]Ding, J.G., Sun, Q.F., Li, K.C., et al., 2009. Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infect. Dis., 9(1):115.

[4]Goto, M., Al-Hasan, M.N., 2013. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin. Microbiol. Infect., 19(6):501-509.

[5]Hilf, M., Yu, V.L., Sharp, J., et al., 1989. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am. J. Med., 87(5):540-546.

[6]Horan, T.C., Andrus, M., Dudeck, M.A., 2008. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control, 36(5):309-332.

[7]Hortiwakul, T., Nagij, S., Chusri, S., et al., 2012. Nosocomial bloodstream infection in Songklanagarind Hospital: outcome and factors influencing prognosis. J. Med. Assoc. Thai., 95(2):170-174.

[8]Jiang, W.D., Ji, C.H., Hu, Q.W., 2007. Dominant disease analysis of Traditional Chinese Medicine Hospital of Zhejiang Province. Zhejiang Stat., 25(6):24-25 (in Chinese).

[9]Kaye, K.S., Marchaim, D., Chen, T.Y., et al., 2014. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J. Am. Geriatr. Soc., 62(2):306-311.

[10]Lambert, M.L., Suetens, C., Savey, A., et al., 2011. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect. Dis., 11(1):30-38.

[11]Lenz, R., Leal, J.R., Church, D.L., et al., 2012. The distinct category of healthcare associated bloodstream infections. BMC Infect. Dis., 12(1):85.

[12]Lim, C.J., Cheng, A.C., Kong, D.C., et al., 2014. Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study. BMC Infect. Dis., 14(1):126.

[13]Lu, Y., Guo, P., Ye, Y.J., et al., 2013. Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a Tertiary-Care Hospital in Beijing. Chin. Med. J. (Engl.), 126(22):4242-4246.

[14]Melzer, M., Welch, C., 2013. Outcomes in UK patients with hospital-acquired bacteraemia and the risk of catheter-associated urinary tract infections. Postgrad. Med. J., 89(1052):329-334.

[15]Mittmann, N., Koo, M., Daneman, N., et al., 2012. The economic burden of patient safety targets in acute care: a systematic review. Drug Healthc. Patient Saf., 4:141-165.

[16]National Health and Family Planning Commission of the People’s Republic of China, 2012. 2012 China health statistics annual inspection. Available from http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2012/index2012.html [Accessed on Aug. 21, 2013].

[17]Neuner, E.A., Yeh, J.Y., Hall, G.S., et al., 2011. Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae bloodstream infections. Diagn. Microbiol. Infect. Dis., 69(4):357-362.

[18]Pedersen, G., Schonheyder, H.C., Sorensen, H.T., 2003. Source of infection and other factors associated with case fatality in community-acquired bacteremia—a Danish population-based cohort study from 1992 to 1997. Clin. Microbiol. Infect., 9(8):793-802.

[19]Rampini, S.K., Bloemberg, G.V., Keller, P.M., et al., 2011. Broad-range 16S rRNA gene polymerase chain reaction for diagnosis of culture-negative bacterial infections. Clin. Infect. Dis., 53(12):1245-1251.

[20]Retamar, P., Portillo, M.M., Lopez-Prieto, M.D., et al., 2011. Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis. Antimicrob. Agents Chemother., 56(1):472-478.

[21]Rodríguez-Créixems, M., Alcala, L., Munoz, P., et al., 2008. Bloodstream infections: evolution and trends in the microbiology workload, incidence, and etiology, 1985-2006. Medicine (Baltimore), 87(4):234-249.

[22]Schmitz, R.P., Keller, P.M., Baier, M., et al., 2013. Quality of blood culture testing—a survey in intensive care units and microbiological laboratories across four European countries. Crit. Care, 17(5):R248.

[23]Schonheyder, H.C., Sogaard, M., 2010. Existing data sources for clinical epidemiology: the North Denmark Bacteremia Research Database. Clin. Epidemiol., 9(2):171-178.

[24]Skogberg, K., Lyytikainen, O., Ollgren, J., et al., 2012. Population-based burden of bloodstream infections in Finland. Clin. Microbiol. Infect., 18(6):E170-E176.

[25]Sogaard, M., Norgaard, M., Dethlefsen, C., et al., 2011. Temporal changes in the incidence and 30-day mortality associated with bacteremia in hospitalized patients from 1992 through 2006: a population-based cohort study. Clin. Infect. Dis., 52(1):61-69.

[26]Tabah, A., Koulenti, D., Laupland, K., et al., 2012. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT international cohort study. Intensive Care Med., 38(12):1930-1945.

[27]Townell, N., McDougall, D., Playford, E.G., 2014. Parenteral nutrition-associated bloodstream infection in an Australian teaching hospital—an 8-year retrospective study of over 11 000 PN-days. Scand. J. Infect. Dis., 46(5):361-367.

[28]Trethon, A., Prinz, G., Varga, A., et al., 2012. Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre. Acta Microbiol. Immunol. Hung., 59(2):271-283.

[29]Uslan, D.Z., Crane, S.J., Steckelberg, J.M., et al., 2007. Age- and sex-associated trends in bloodstream infection: a population-based study in Olmsted County, Minnesota. Arch. Intern. Med., 167(8):834-839.

[30]Wei, Z.Q., Shen, P., Chen, Y.B., et al., 2012. Mohnarin report of 2010: bacterial composing and resistance in bloodstream infections. Chin. J. Nosocomiol., 22(3):465-470 (in Chinese).

[31]Weinstein, M.P., Murphy, J.R., Reller, L.B., et al., 1983. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. II. Clinical observations, with special reference to factors influencing prognosis. Clin. Infect. Dis., 5(1):54-70.

[32]Wisplinghoff, H., Bischoff, T., Tallent, S.M., et al., 2004. Nosocomial bloodstream infections in US hospitals: analysis of 24 179 cases from a prospective nationwide surveillance study. Clin. Infect. Dis., 39(3):309-317.

[33]Ye, J.J., Huang, C.T., Shie, S.S., et al., 2010. Multidrug resistant Acinetobacter baumannii: risk factors for appearance of imipenem resistant strains on patients formerly with susceptible strains. PLoS ONE, 5(4):e9947.