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Differences in microbiological profile between community-acquired, healthcare-associated and hospital-acquired
Teresa Cardoso1, Orquídea Ribeiro, Irene Aragão
1Unidade de Cuidados Intensivos Polivalente. Hospital de Santo António. Centro Hospitalar do Porto. Universidade do Porto. Porto. Portugal.. cardoso.tmc@gmail.com.
Introduction:
Microbiological profiles were analysed and compared for intra-abdominal, urinary, respiratory and bloodstream infections according to place of acquisition: community-acquired, with a separate analysis of healthcare-associated, and hospital-acquired.
Material And Methods:
Prospective cohort study performed at a university tertiary care hospital over 1 year. Inclusion criteria were meeting the Centers for Disease Control definition of intra-abdominal, urinary, respiratory and bloodstream infections.
Results:
A total of 1035 patients were included in the study. More than 25% of intra-abdominal infections were polymicrobial; multi-drug resistant gram-negatives were 38% in community-acquired, 50% in healthcare-associated and 57% in hospital-acquired. E. coli was the most prevalent among urinary infections: 69% in community-acquired, 56% in healthcare-associated and 26% in hospital-acquired; ESBL producers' pathogens were 10% in healthcare-associated and 3% in community-acquired and hospital-acquired. In respiratory infections Streptococcus pneumoniae was the most prevalent in community-acquired (54%) and MRSA in healthcare-associated (24%) and hospital-acquired (24%). A significant association was found between MRSA respiratory infection and hospitalization in the previous year (adjusted OR = 6.3), previous instrumentation (adjusted OR = 4.3) and previous antibiotic therapy (adjusted OR = 5.7); no cases were documented among patients without risk factors. Hospital mortality rate was 10% in community-acquired, 14% in healthcare-associated and 19% in hospital-acquired infection.
Discussion And Conclusion:
This study shows that healthcare-associated has a different microbiologic profile than those from community or hospital acquired for the four main focus of infection. Knowledge of this fact is important because the existing guidelines for community-acquired are not entirely applicable for this group of patients.
Insights
Healthcare-associated infections show distinct microbial patterns compared to community or hospital-acquired infections. Understanding these differences is crucial for effective treatment and management strategies.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Microbiological profiles of infections vary significantly based on acquisition source: community-acquired, healthcare-associated, and hospital-acquired.
- Analysis focused on intra-abdominal, urinary, respiratory, and bloodstream infections.
Purpose of the Study:
- To compare the microbiological characteristics of infections based on their place of acquisition.
- To highlight differences between community-acquired, healthcare-associated, and hospital-acquired infections.
Main Methods:
- Prospective cohort study conducted at a university tertiary care hospital over one year.
- Inclusion criteria followed the Centers for Disease Control definitions for four major infection types.
- Analysis included microbiological profiling and comparison across acquisition settings.
Main Results:
- Healthcare-associated infections demonstrated a higher prevalence of multi-drug resistant gram-negatives (50%) compared to community-acquired (38%) and hospital-acquired (57%).
- Escherichia coli was most prevalent in community-acquired urinary infections (69%), decreasing in healthcare-associated (56%) and hospital-acquired (26%) settings.
- Methicillin-resistant Staphylococcus aureus (MRSA) was prevalent in healthcare-associated and hospital-acquired respiratory infections (24% each), with significant associations to prior hospitalization, instrumentation, and antibiotic therapy.
Conclusions:
- Healthcare-associated infections possess a unique microbiological profile distinct from community or hospital-acquired infections.
- Current treatment guidelines for community-acquired infections may not be fully applicable to healthcare-associated infections.
- Recognizing these differences is vital for optimizing patient care and antimicrobial stewardship.
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