Clinical and Microbiological Analysis of Community-acquired Bacteremia Admitted to a Tertiary Teaching Hospital

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  • YAMADA Tomoko
    Intensive Care Unit, Saga University Hospital
  • HAMADA Yohei
    Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital
  • MAGARIBUCHI Hiroki
    Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital
  • NAGATA Masaki
    Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital
  • FUKUOKA Mami
    Division of Infectious Disease and Hospital Epidemiology, Saga Prefectural Hospital KOSEIKAN
  • KUSABA Koji
    Clinical Laboratory of Microbi ology, Saga University Hospital
  • NAGASAWA Zenzo
    Clinical Laboratory of Microbi ology, Saga University Hospital
  • SAKAGUCHI Yoshiro
    Intensive Care Unit, Saga University Hospital
  • AOKI Yosuke
    Division of Infectious Disease and Hospital Epidemiology, Saga University Hospital

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Other Title
  • 三次医療機関に入院した市中菌血症の臨床・微生物学的解析
  • サンジ イリョウ キカン ニ ニュウイン シタ シ ジュウ キンケッショウ ノ リンショウ ・ ビセイブツガクテキ カイセキ

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Abstract

Objectives: To investigate clinical and microbiological characteristics of community-acquired bacteremia (CAB). Methods: We retrospectively analyzed subjects with CAB hospitalized at Saga University Hospital between January 2009 and September 2011. We investigated causative organisms, primary infection sites, and subject summaries and complications, and analyzed the mortality factor. Results: CAB incidence was 185 cases, with 192 organisms cultured. Causative organisms were gram-positive bacteria in 81 strains (42％), 9 (11％) of which were methicillin-resistant Staphylococcus aureus (MRSA). Gram-negative bacteria were identified in 111 strains (58％), with 80％ Enterobacteriaceae. Five of the 111 (5％) were caused by extended-spectrum β-lactamase (ESBL) producing bacteria. The most frequent bacteremia portal was intra-abdominal infection (29％, 54/185). During hospitalization of 1-180 days, 20 subjects eventually died. Neutropenia on admission was associated with significantly higher mortality than without (30％vs 3％, p＜0.001). Septic shock rates were higher in non-survivors than survivors (45％vs 14％, p＝0.002), and more complications were documented in non-survivors than survivors (50％vs 25％, p＝0.017). No specific pathogen or primary infection site was associated with higher mortality. Conclusions: Antimicrobial-resistant pathogens such as MRSA and ESBL producers should be considered even in CAB, especially in subjects with healthcare-associated infection, regardless of how small the number. The CAB treatment course should consider subjects summaries, severity, and complications.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 87 (1), 6-13, 2013

    The Japanese Association for Infectious Diseases

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