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Many hospital-onset bloodstream infections may be misclassified
In an 8-year study, researchers found that 14.4% of bloodstream infections identified in patients within 2 weeks of hospital discharge had been acquired during hospitalization and would have been misclassified as health care-associated community onset bloodstream infections — rather than hospital-onset infections — without the inclusion of their history.
Such misclassifications may lead to an underestimation of hospital infection risk, said Riad Khatib, MD, and colleagues from Ascension St. John Hospital in Grosse Pointe Woods, Michigan.
“Bloodstream infections (BSIs) used to be classified as community-associated (CA) or nosocomial. With more care provided outside hospital settings, nosocomial classification was considered obsolete and was replaced by health care-associated BSI (HCA-BSI), which includes community-onset (HCA-CO) BSI if the blood culture was collected within 3 days of facility admission from patients with defined health care exposure, and hospital onset (HO) if collected 4 days or more after facility admission,” they wrote. “Accurate classification, however, requires the examination of historical information of individual patients.”
To determine the frequency of recent hospitalization of patients with BSIs to classify the cases, Khatib and colleagues reviewed blood culture results from patients with BSI between Jan. 1, 2010, and Dec. 31, 2017. According to the study, they reviewed medical records of all patients to determine the source of the infection. Additionally, BSIs in patients discharged within 14 days were reviewed further to determine if they were hospital onset during prior hospitalization (HO-PH) or HCA-CO infections.
In total, Khatib and colleagues reviewed 5,946 BSI episodes, 72.7% of which were considered CO cases. Of these, they found that prior hospitalization within the preceding 1 to 14 days was documented in 756 of cases, including 213 within 1 to 3 days of discharge and 543 within 4 to 14 days of discharge. Among recently discharged patients with bloodstream infections, 109 (14.4%) were categorized as HO-PH, they reported.
According to the study, the most common source of infection among patients with HO-PH infections discharged within 1 to 3 days was surgical site infection (38.8%), followed by intravascular catheter within 3 days of discharge (35.4%), UTI within 1 day of discharge (16.9%), and pneumonia in patients with ventilatory support (9.2%). Among patients discharged within 4 to 14 days, the primary cause was surgical site infection, including wound infection and osteomyelitis (68.2%), peritonitis (18.2%), endocarditis (4.5%) and endometritis (4.5%).
“Based on these observations, a closer evaluation is needed for patients who are rehospitalized, presenting with infection. The artificial labeling of HO based on days of admission may miss important information that has infection prevention ramifications,” the authors concluded. “Additionally, a consensus for classification of BSI in patients with recent hospitalization is needed.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.