Revista argentina de microbiología
versión On-line ISSN 1851-7617
NAZAR, J. R.; LAVADOS, A.; DAHER, O. y BISCHOFF, M. C.. Microbiological and epidemiological analysis, and clinical outcome of patients with bloodstream infection from an Esquel hospital in the period 2007-2009. Rev. argent. microbiol. [online]. 2010, vol.42, n.3, pp. 151-164. ISSN 1851-7617.
In order to evaluate the bacteremic episodes, the blood cultures performed in 867 patients during a 29-month period were reviewed. The incidence of significant bloodstream infections was 10/1000 admissions/year. About 47% of bacteremias were community-acquired (CAB), 22% nosocomial (NB), and 31% health care-associated (HCAB). The five most common pathogens were: Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus spp. and coagulase-negative staphylococci, whereas the main sources were: respiratory, intraabdominal and unknown. The major organism in CAB was S. pneumoniae, and S. aureus in NB and HCAB. The ineffective empirical-antimicrobial-therapy [IEAT (total 26.5%)] was much higher in NB and HCAB vs. CAB (p < 0.05). There was no significant difference in mortality and IEAT between known vs. unknown sources. Old age (≥ 70 yrs), previous antibiotic therapy, hospitalization in clinical medical services, Enterococcus spp. and methicillin-resistant Staphylococcus isolates were more associated with IEAT (p < 0.05). Previous antibiotic therapy and longer hospital stays were more common in NB vs. CAB and HCAB (p < 0.05). Overall and septicemia-associated mortality was 28.9% and 21.7%, respectively. Univariate associations with increased mortality (p < 0.05) included: hypothermia, WBC < 1499/mm3, hypotension, presentation with septic-shock, hospital-stay ≤ 10 days, and polymicrobial bacteremia. The early administration of effective empirical antimicrobial therapy according to our epidemiological characteristics and an aggressive hemodynamic treatment in presence of septic shock could reduce bacteremia-associated morbidity and mortality, costs and length of hospital stays.
Palabras clave : Bloodstream infection; Initial empirical antimicrobial therapy; Septicemia-associated mortality; Community- acquired bacteremia; Nosocomial bacteremia; Health care-associated bacteremia.