This article is more than 5 years old. Information may no longer be current.
Patients with BSIs at community hospitals often receive inappropriate antibiotics
Click Here to Manage Email Alerts
At community hospitals, one of three patients with a bloodstream infection receives inappropriate, empiric antimicrobial therapy, according to data from a retrospective study published in PLoS One.
Other findings in the study indicate that at community hospitals, community-onset, health care-associated bloodstream infections (BSIs) are the most common and Staphylococcus aureus the most common cause.
“Our study provides a much-needed update on what we’re seeing in community hospitals, and ultimately, we’re finding similar types of infections in these hospitals as in tertiary care centers,” Deverick Anderson, MD, MPH, associate professor of medicine at Duke University, said in a press release. “It’s a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement in both kinds of hospital settings.”
Deverick Anderson
The study included adult patients admitted to nine community hospitals in North Carolina and Virginia from 2003 to 2006. During the study period, 5,124 patients had a BSI during 1,371,467 patient-days. The cohort included a random sample of 1,470 unique patients.
Fifty-six percent of the BSIs were community-onset, health care-associated infections. Community-associated infections accounted for 29% of the infections and hospital-onset, health care–associated infections accounted for 15% of the infections.
Multidrug-resistant pathogens were present in 340 (23%) patients. The most common pathogen was S. aureus, which was found in 428 (28%) patients. MRSA was the most common MDR pathogen, found in 203 (13%) patients. The in-hospital mortality rate was 18% and patients with prior health care exposure were almost three times more likely to die (OR=2.78; 95% CI, 1.94-4).
Inappropriate empiric antimicrobial therapy was administered to 542 (38%) patients. Multivariable analysis found factors that were independently associated with receiving inappropriate therapy, including the hospital where the patient received care; assistance with three or more activities of daily living; Charlson score; community-onset, health care-associated infection; and hospital-onset, health care-associated infection.
“Similar patterns of pathogens and drug resistance have been observed in tertiary care centers, suggesting that bloodstream infections in community hospitals aren’t that different from tertiary care centers,” Anderson said. “There’s a misconception that community hospitals don’t have to deal with S. aureus and MRSA, but our findings dispel that myth, since community hospitals also see these serious infections.”
Anderson advised clinicians in community hospitals to focus on these risk factors when choosing antibiotic therapy for these patients. Most risk factors for receiving inappropriate therapy are already recorded in electronic health records.
“Developing an intervention where electronic records automatically alert clinicians to these risk factors when they’re choosing antibiotics could help reduce the problem,” Anderson said. “This is just a place to start, but it’s an example of an area where we could improve how we treat patients with bloodstream infections.”
Disclosure: Anderson has received research support from the CDC, the Agency for Healthcare Research and Quality, and Merck, and he receives royalties from UpToDate, Online.
Click Here to Manage Email Alerts