1100. 14-Year Survey in a Swedish County Reveals an Alarming Increase in Bloodstream Infections (BSI). Comorbidity - an Independent Risk Factor for Both BSI and Mortality
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background:Bloodstream infection (BSI) is a major cause of morbidity and mortality worldwide and several measures have been taken to prevent BSI and increase survival in sepsis. The number of BSIs and number of deaths following BSI in Europe and North America each year have been estimated to be almost 2 million and 250,000 respectively. Sweden has one of Europe’s lowest outpatient antibiotic consumption. It is not known how this influences the incidence of community-onset BSI since there is no national BSI register. In this study we assessed the incidence, risk factors and outcome of all BSIs over a 14-year period in a county in Sweden having four hospitals and almost half a million inhabitants. BSIs were defined as either hospital-acquired or community-onset

Methods: retrospective cohort study on culture confirmed BSI among patients in the county of Östergötland, Sweden, with approximately 440,000 inhabitants. A BSI was defined as either community-onset BSI (CO-BSI) or hospital-acquired BSI (HA-BSI). We used, with small modifications, the same BSI definitions as Ammerlaan et al, CID 2013.

Results: of a total of 11,480 BSIs, 67% were CO-BSI and 33% HA-BSI. The incidence of BSI increased by 64% from 945 to 1,546 per 100,000 hospital admissions per year during the study period. The most prominent increase, 83% was observed within the CO-BSI cohort whilst HA-BSI increased by 32%. Prescriptions of antibiotics in outpatient care decreased with 24 % from 422 to 322 prescriptions dispensed/1,000 inhabitants/year, whereas antibiotics prescribed in hospital increased by 67% (from 424 to 709 DDD per 1,000 days of care). The overall 30-day mortality for HA-BSIs was 17.2%, compared to 10.6 % for CO-BSIs, with an average yearly increase per 100,000 hospital admissions of 2 and 5% respectively. The proportion of patients with one or more comorbidities, increased from 20.8 to 55.3%. In multivariate analyses, risk factors for mortality within 30 days were: HA-BSI (2.22); two or more comorbidities (1.89); single comorbidity (1.56); CO-BSI (1.21); male (1.05); and high age (1.04).

Conclusion: this survey revealed an alarming increase in the incidence of BSI over the 14-year study period. Interventions to decrease BSI in general should be considered together with robust antibiotic stewardship programmes to avoid both over- and underuse of antibiotics.

Martin Holmbom, MD1, Christian Giske, MD, Associate Professor2, Lennart E Nilsson, Professor, PhD3, Mikael Hoffmann, MD, PhD4, Mats Fredriksson, PhD, Associate Professor5, Carina Claesson, PhD6, Åse Östholm-Balkhed, MD, PhD7 and Hakan Hanberger, Professor, MD7, (1)Infectious Diseases and Urology, Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences. Linköping University, Linköping, Sweden, (2)Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden, (3)Clinical Microbiology, Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden, (4)The NEPI foundation, Division of Health Care Analysis, Faculty of Medicine and Health Sciences, Linköping university, Linköping, Sweden, (5)Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden, (6)Clinical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden, (7)Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden

Disclosures:

M. Holmbom, None

C. Giske, None

L. E. Nilsson, None

M. Hoffmann, None

M. Fredriksson, None

C. Claesson, None

Å. Östholm-Balkhed, None

H. Hanberger, None

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