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Bloodstream Infections in a Community Hospital: A 25-Year Follow-Up

Published online by Cambridge University Press:  02 January 2015

William E. Scheckler ,
James A. Bobula ,
Mark B. Beamsley  and
Scott T. Hadden
William E. Scheckler*
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
James A. Bobula
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
Mark B. Beamsley
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
Scott T. Hadden
Affiliation:
University of Wisconsin Medical Schooland St. Marys Hospital Medical Center, Madison, Wisconsin
*
University of Wisconsin, Department of Family Medicine, 777 South Mills Street, Madison, WI 53715
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Abstract

Objective:

To examine the current status of bloodstream infections (BSIs) in a community hospital as part of a 25-year longitudinal study.

Design:

Retrospective descriptive epidemiologic study.

Setting:

Community teaching hospital.

Patients:

All inpatients in 1998 with a positive blood culture who met the CDC NNIS System case definition of BSI.

Methods:

Cases were stratified by underlying illness category using case mix adjustment categories (after McCabe) and reviewed for associations among mortality, underlying illness severity, and multiple clinical and laboratory parameters.

Results:

Of 19,289 patients discharged in 1998,185 had an episode of infection documented by blood culture (96 cases per 10,000 inpatients). BSI was twice as frequent in patients 65 years and older compared with younger patients. BSIs caused or contributed to the deaths of 22 patients for an overall case-fatality rate of 11.9% compared with 20.7% in 1982 (P = .02). Striking decreases were noted for in-hospital patient mortality in 1998 for BSIs with ultimately and rapidly fatal underlying illnesses (P = .02 and P < .10, respectively). Primary bacteremia decreased compared with 1982. Antibiotic use was vigorous, but resistance was modest in both nosocomial and community-acquired organisms and had changed little from 1982 and 1987.

Conclusions:

Compared with previous studies, case-fatality rates in patients with BSI were substantially lower in rapidly fatal and ultimately fatal underlying illness categories. Antibiotic use was extensive but prompt and appropriate. Microorganism resistance to antibiotics changed little from the 1980s.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 936 - 941
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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