814. Location of Acquisition Impacts the Discharge Status and Length of Stay of Patients with Gram-Positive Bloodstream Infections in Community Hospitals
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDSA Poster GP BSI_10-6-15 .pdf (356.1 kB)
  • Background:  We investigated the association between location of acquisition (LOA) of gram-positive (GP) bloodstream infections (BSI) in community hospitals with other known infectious risk factors and outcomes.

    Methods:  We performed a retrospective, multicenter cohort study of adult inpatients with GP BSI in 9 community hospitals from 2003-2006.  LOA was defined by CDC criteria:  1) community-acquired (CAQ), 2) healthcare-associated (HAS) as BSI <48 hours after admission plus ≥1 of the following healthcare risk factors:  hospitalization, surgery, dialysis, invasive device, or residence in long-term care facility in the prior 12 months, and 3) hospital-acquired (HAQ) as BSI ≥48 hours after hospital admission.  Categorical variables were reported as proportions and compared by χ2 test.  Continuous variables were summarized by median and interquartile range (IQR) and compared by ANOVA.  P-value <0.05 was considered significant.  

    Results:  748 patients were included in the analysis with characteristics summarized in Table 1.  Patients with HAS or HAQ GP BSI were significantly more likely to be older, dependent on at least one activity of daily living, have higher Charlson scores, urinary catheter present on admission, and urinary sources of infection.  Those with CAQ BSI were more likely to have lower respiratory tract source of infection, streptococcal BSI, and be discharged home.  Patients with HAS BSI were more likely to have dementia, methicillin-resistant S. aureus BSI, and be discharged to a nursing home.  Patients with HAQ BSI were more likely to have coagulase-negative staphylococcal BSI, be admitted to the ICU at the time of BSI, and have a longer median duration of hospitalization.  

    Conclusion:  LOA was associated with multiple distinct infectious risk factors for patients with GP BSI in community hospitals.  Distinguishing LOA in a patient presenting with suspected GP BSI is a critical assessment that should influence empiric treatment patterns.


    Table 1

    Characteristic

    CAQ

    N=459 (61)

    HAS

    N=160 (21)

    HAQ

    N=129 (17)

     

    P-value

    Age

    60, 25

    77, 21

    66, 25

    <0.05

    Charlson score

    2, 3

    3, 3

    3, 4

    <0.05

    ICU admission within 1 week after BSI

    123 (27)

    40 (25)

    61 (47)

    <0.05

    Total duration of hospitalization (days)

    6, 8

    8, 8

    9, 16

    <0.05

    Died

    66 (14)

    45 (28)

    37 (29)

    0.08

    Discharged Home

    246 (54)

    27 (17)

    33 (26)

    <0.05

    Discharged to Nursing Home

    36 (8)

    71 (44)

    32 (25)

    <0.05

    Julia Messina, MD, MSc1,2, Rebekah W. Moehring, MD, MPH1, Vance G. Fowler Jr., MD1,2, Daniel J. Sexton, MD, FIDSA, FSHEA1 and Deverick Anderson, MD, MPH, FIDSA, FSHEA3, (1)Duke University Medical Center, Durham, NC, (2)Duke Clinical Research Institute, Durham, NC, (3)Division of Infectious Diseases, Duke University Medical Center, Durham, NC

    Disclosures:

    J. Messina, None

    R. W. Moehring, None

    V. G. Fowler Jr., Merck: Investigator and Scientific Advisor , Consulting fee and Research support
    Pfizer: Consultant and Investigator , Consulting fee and Research support
    Novartis: Consultant and Investigator , Consulting fee and Research support
    Galderma: Consultant , Consulting fee
    Novadigm: Consultant , Consulting fee
    Durata: Consultant , Consulting fee
    Debiopharm: Consultant , Consulting fee
    Genentech: Consultant , Consulting fee
    Achaogen: Consultant , Consulting fee
    Affinium: Consultant , Consulting fee
    Medicines Co.: Consultant , Consulting fee
    Cerexa: Consultant and Investigator , Consulting fee and Research support
    Tetraphase: Consultant , Consulting fee
    Trius: Consultant , Consulting fee
    MedImmune: Consultant and Investigator , Consulting fee and Research support
    Bayer: Consultant , Consulting fee
    Theravance: Consultant and Investigator , Consulting fee and Research support
    Cubist: Consultant and Investigator , Consulting fee and Research support
    Basilea: Consultant , Consulting fee
    Advanced Liquid Logics: Investigator , Research support
    Green Cross: educational development , Consulting fee

    D. J. Sexton, None

    D. Anderson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.