Background: Bloodstream infections (BSI) have been traditionally classified as either community acquired (CA) or\r\nhospital acquired (HA) in origin. However, a third category of healthcare-associated (HCA) community onset disease\r\nhas been increasingly recognized. The objective of this study was to compare and contrast characteristics of HCABSI\r\nwith CA-BSI and HA-BSI.\r\nMethods: All first episodes of BSI occurring among adults admitted to hospitals in a large health region in Canada\r\nduring 2000-2007 were identified from regional databases. Cases were classified using a series of validated\r\nalgorithms into one of HA-BSI, HCA-BSI, or CA-BSI and compared on a number of epidemiologic, microbiologic,\r\nand outcome characteristics.\r\nResults: A total of 7,712 patients were included; 2,132 (28%) had HA-BSI, 2,492 (32%) HCA-BSI, and 3,088 (40%) had\r\nCA-BSI. Patients with CA-BSI were significantly younger and less likely to have co-morbid medical illnesses than\r\npatients with HCA-BSI or HA-BSI (p < 0.001). The proportion of cases in males was higher for HA-BSI (60%; p <\r\n0.001 vs. others) as compared to HCA-BSI or CA-BSI (52% and 54%; p = 0.13). The proportion of cases that had a\r\npoly-microbial etiology was significantly lower for CA-BSI (5.5%; p < 0.001) compared to both HA and HCA (8.6 vs.\r\n8.3%). The median length of stay following BSI diagnosis 15 days for HA, 9 days for HCA, and 8 days for CA (p <\r\n0.001). Overall the most common species causing bloodstream infection were Escherichia coli, Staphylococcus\r\naureus, and Streptococcus pneumoniae. The distribution and relative rank of importance of these species varied\r\naccording to classification of acquisition. Twenty eight day all cause case-fatality rates were 26%, 19%, and 10% for\r\nHA-BSI, HCA-BSI, and CA-BSI, respectively (p < 0.001).\r\nConclusion: Healthcare-associated community onset infections are distinctly different from CA and HA infections\r\nbased on a number of epidemiologic, microbiologic, and outcome characteristics. This study adds further support\r\nfor the classification of community onset BSI into separate CA and HCA categories.
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