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Antibiotic-resistant bloodstream infections in hospitalized patients: specific risk factors in a high-risk
Heike von Baum1, J F Ober, C Wendt
1Department of Medical Microbiology and Hygiene, Section Hospital Hygiene, University of Ulm, Steinhövelstr. 9, 89075 Ulm, Germany. heike.von-baum@medizin.uni-ulm.de
Background:
The aim of this study was to explore characteristics that are associated with bloodstream infections due to specific multiresistant microorganisms (methicillinresitant Staphylococcus aureus, MRSA; vancomycin-resistant enterococci, VRE; third-generation cephalosporin-resistant Enterobacteriaceae) or Candida spp. in hospitalized patients.
Patients And Methods:
All patients who experienced a bloodstream infection with one of the aforementioned pathogens between September 1999 and October 2001 were included into a statistical analysis of independent risk factors. The possible impact of previous antibiotic and antifungal therapies was evaluated.
Results:
Of the study population, 22% had two or more episodes with different pathogens. In the 314 patients with a single bloodstream infection MRSA was isolated in 189 patients, VRE in 31, Enterobacteriaceae in 13, and Candida spp. in 80 patients. Crude mortality was high in the study population (overall 40%) and varied between 33% (MRSA bacteremia only) and 58% (VRE bacteremia only). Patients who yielded more than one of the pathogens under surveillance had crude mortalities ranging from 41% to 83% (all four pathogens). In this group of high-risk patients, the following factors were independently associated with the individual pathogen: prior chemotherapy (OR 4.88 CI(95) 1.50-15.87) and bronchoscopy (OR 3.17 CI(95) 1.05-9.52) for VRE patients; burns (OR 4.50 CI(95) 0.90-22.73), presence of a tracheostomy (OR 4.22 CI(95) 1.15-15.38) and acute dialysis (OR 3.62 CI(95) 0.99-13.16) for patients with Enterobacteriaceae; and an underlying malignant disease (OR 1.98 CI95 0.99-3.97), performance of a bowel endoscopy (OR 2.80 CI(95) 1.27-6.13) and presence of a central venous catheter (CVC) (OR 12.34 CI(95) 1.63-90.91) for patients with candidemia.
Conclusion:
Patients with bacteremia due to VRE, Enterobacteriaceae or Candida spp. had more severe risk factors associated with the respective pathogen than patients with MRSA bacteremia.
Insights
This study identified risk factors for bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Candida species in hospitalized patients. Patients with VRE, Enterobacteriaceae, or Candida infections had more severe risk factors than those with MRSA.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Hospitalized patients are at risk for bloodstream infections (BSIs) caused by multidrug-resistant organisms.
- Specific pathogens include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), third-generation cephalosporin-resistant Enterobacteriaceae, and Candida species.
Purpose of the Study:
- To identify patient characteristics and clinical factors associated with BSIs caused by specific multidrug-resistant pathogens.
- To evaluate the impact of prior antibiotic and antifungal therapies on the development of these infections.
Main Methods:
- A retrospective statistical analysis was conducted on hospitalized patients with BSIs between September 1999 and October 2001.
- Independent risk factors for specific pathogens were analyzed, including patient demographics, medical history, and procedures.
Main Results:
- Of 314 patients with single BSIs, MRSA was most common (189), followed by Candida spp. (80), VRE (31), and Enterobacteriaceae (13).
- Crude mortality was 40% overall, ranging from 33% for MRSA to 58% for VRE.
- Independent risk factors included chemotherapy and bronchoscopy for VRE; burns, tracheostomy, and dialysis for Enterobacteriaceae; and malignancy, bowel endoscopy, and central venous catheter (CVC) for candidemia.
Conclusions:
- Patients with BSIs due to VRE, Enterobacteriaceae, or Candida spp. exhibited more severe associated risk factors compared to those with MRSA bacteremia.
- Identifying these specific risk factors can aid in targeted prevention and management strategies for multidrug-resistant BSIs.
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