316. Factors Associated with Bloodstream Infection Present on Hospital Admission
Session: Poster Abstract Session: HAI: Epidemiology
Thursday, October 8, 2015
Room: Poster Hall
Background:

Recent studies have reported increased rates of bloodstream infections (BSI) present among patients at hospital admission (POA).  Our aim was to measure incidence and characteristics of patients with BSI POA, and determine whether admission from a skilled nursing facility (SNF) predicted BSI POA.

Methods:

We conducted a retrospective cohort study of adult patients (N=560,562) discharged from one community and two tertiary/quaternary care hospitals in New York City from 2006-2012. Data were obtained from electronic laboratory and administrative records, including POA International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes.  POA BSI was defined as positive blood culture within 48 hours of hospitalization.  Admission from SNF was determined by patient’s admitting address.  Comorbidities and Charlson Comorbidity Index (CCI) were also recorded.  Logistic regression was used to determine associations between patient characteristics and POA BSI.  For patients admitted >1 time with POA BSI (N=744), only the first was included. 

 Results:

First time BSI POA were identified in 7,065 admissions (1.4%).  Associations between BSI POA and patient characteristics are presented in the Table.

Table. Associations between Admission Source, Patient Characteristics and POA BSI

 

N (%) or *mean (standard deviation)

Odds Ratio

(95% Confidence Interval)

Admission from SNF

12,200 (2.2)

2.36 (2.15-2.58)

Age (reference=18-64 years)

 

 

65-84 years

177,877 (31.7)

1.16 (1.10-1.22)

≥85 years

45,718 (8.2)

1.59 (1.48-1.71)

Burns

3,329 (0.6)

0.14 (0.06-0.34)

CCI

*2.1 (3.4)

1.03 (1.03-1.04)

Chronic dermatitis

25,775 (4.6)

2.40 (2.24-2.57)

Male (reference=female)

250,724 (44.7)

1.22 (1.16-1.28)

Malignancies

76,777 (13.7)

1.49 (1.39-1.59)

Renal failure

81,711 (14.6)

2.76 (2.62-2.91)

Wounds

3,740 (0.7)

0.50 (0.33-0.74) 

Conclusion:

BSI POA was independently associated with admission from SNF, age, CCI, male, and POA chronic dermatitis, malignancies, and renal failure.  POA burns and wounds were inversely associated with BSI POA.  This may be because acute burns or wounds were the reason for hospitalization, and resulting infections would not develop until >48 hours after admission.

Sainfer Aliyu, MSEd, MHPM, BSN, RN1, Bevin Cohen, MPH, MPhil1 and Elaine Larson, RN, PhD, FAAN, CIC, FIDSA, FSHEA2, (1)Columbia University School of Nursing, New York, NY, (2)School of Nursing, Columbia University Medical Center, New York, NY

Disclosures:

S. Aliyu, None

B. Cohen, None

E. Larson, None

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