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Journal of Clinical Microbiology, August 2003, p. 3655-3660, Vol. 41, No. 8
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.8.3655-3660.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Epidemiology and Outcome of Nosocomial and Community-Onset Bloodstream Infection

D. J. Diekema,1,2 S. E. Beekmann,2 K. C. Chapin,3 K. A. Morel,3 E. Munson,2 and G. V. Doern2*

Division of Infectious Diseases, Department of Internal Medicine,1 Division of Medical Microbiology, Department of Pathology, Roy J. and Lucille A. Carver University of Iowa College of Medicine, Iowa City, Iowa,2 Division of Medical Microbiology, Department of Pathology, Lahey Clinic, Burlington, Massachusetts3

Received 20 December 2002/ Returned for modification 1 May 2003/ Accepted 4 June 2003

We performed a prospective study of bloodstream infection to determine factors independently associated with mortality. Between February 1999 and July 2000, 929 consecutive episodes of bloodstream infection at two tertiary care centers were studied. An ICD-9-based Charlson Index was used to adjust for underlying illness. Crude mortality was 24% (14% for community-onset versus 34% for nosocomial bloodstream infections). Mortality attributed to the bloodstream infection was 17% overall (10% for community-onset versus 23% for nosocomial bloodstream infections). Multivariate logistic regression revealed the independent associations with in-hospital mortality to be as follows: nosocomial acquisition (odds ratio [OR] 2.6, P < 0.0001), hypotension (OR 2.6, P < 0.0001), absence of a febrile response (P = 0.003), tachypnea (OR 1.9, P = 0.001), leukopenia or leukocytosis (total white blood cell count of <4,500 or >20,000, P = 0.003), presence of a central venous catheter (OR 2.0, P = 0.0002), and presence of anaerobic organism (OR 2.5, P = 0.04). Even after adjustments were made for underlying illness and length of stay, nosocomial status of bloodstream infection was strongly associated with increased total hospital charges (P < 0.0001). Although accounting for about half of all bloodstream infections, nosocomial bloodstream infections account for most of the mortality and costs associated with bloodstream infection.

* Corresponding author. Mailing address: Medical Microbiology Division, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 356-8616. Fax: (319) 356-4916. E-mail: gary-doern{at}uiowa.edu.

Journal of Clinical Microbiology, August 2003, p. 3655-3660, Vol. 41, No. 8
0095-1137/03/$08.00+0     DOI: 10.1128/JCM.41.8.3655-3660.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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