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Community-acquired bacteremia at a teaching versus a nonteaching hospital: Impact of acute severity of illness on 30-day mortality*

https://doi.org/10.1067/mic.2001.110567Get rights and content

Abstract

Background: Few studies have focused recently on the epidemiology of community-acquired bacteremia (CAB) and there have been few comparisons of CAB in teaching versus nonteaching hospitals. Objectives: To compare the clinical characteristics, acute severity of illness, and 30-day mortality of patients with CAB admitted to a teaching and a nonteaching hospital and to define predictors of 30-day mortality among patients with CAB that would be identifiable at the time of admission to the hospital. Methods: This was a retrospective study of CAB at a teaching hospital (n = 174 episodes) compared to a community nonteaching hospital (n = 74 episodes) during 1995. Data collected included demographic characteristics, underlying diseases, sources of CAB, and antimicrobial therapy. Acute severity of illness on admission was measured by using the acute physiology score component of the Acute Physiology and Chronic Health Evaluation III system (APS APACHE III). Main Outcome Measure: Status, dead or alive, 30 days after admission for CAB. Results: At the nonteaching hospital, patients were older but, on average, significantly less acutely ill (as measured by the admission APS APACHE III score) than were those at the teaching hospital. In contrast, patients with HIV infection, posttransplantation, or on hemodialysis were identified only at the teaching hospital. Overall, organisms causing CAB at both hospitals were similar except that Staphylococcus aureus CAB occurred significantly more often at the teaching hospital and Escherichia coli CAB occurred more often at the nonteaching hospital. There was no significant difference in 30-day mortality in patients with CAB between the teaching hospital (19.3%) and the nonteaching hospital (16.7%; P =.63). APS APACHE III score on admission identified episodes of CAB with a low- and a high-risk for 30-day mortality at both hospitals. Independent predictors of 30-day mortality were APACHE III score on admission (P <.001) and pneumonia as a source of CAB (P =.012). Conclusions: Among patients with CAB, acute severity of illness on admission was the most important predictor of 30-day mortality at both hospitals. Even though patients with CAB were, on average, more severely ill at the time of admission to the teaching hospital, 30-day mortality rates were not significantly different between the two hospitals because deaths correlated with high APS APACHE III scores at both facilities. The APS APACHE III score on admission provides important prognostic information among patients with CAB. (AJIC Am J Infect Control 2001;29:13-9)

Section snippets

Setting

This study was performed at two hospitals in the greater Buffalo, NY, region. The Erie County Medical Center (ECMC) is an urban, public hospital and is a major teaching hospital for the School of Medicine and Biomedical Sciences, State University of New York at Buffalo. It has 400 beds and provides both primary and tertiary care for a diverse patient population. It not only serves the indigent population but also provides tertiary care for the region including a Level I Trauma Unit, a regional

Demographic and clinical characteristics

During 1995, there were 174 episodes of CAB identified among patients admitted to the teaching hospital for an incidence of 12.9 episodes per 1000 admissions and 75 CAB episodes among those admitted to the nonteaching hospital or 11.6 episodes per 1000 admissions. A comparison of clinical characteristics of these two groups is shown in Table 1.Patients at the nonteaching hospital were, on average, older but less acutely ill, as determined by the mean APS APACHE III score on admission, compared

Discussion

In studies published in recent years, CAB has been evaluated in combination with hospital-acquired bacteremia,3, 4, 6, 7, 8, 9, 10, 11, 12 in a specific group of patients (eg, the elderly15 or those with AIDS,16) or due to a specific organism. Few studies have evaluated CAB in the setting of a nonteaching hospital.3, 4, 11 There has been only one study5 published in the past 15 years that has exclusively focused on CAB.5 Our study provides updated information on the epidemiology and outcome of

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    *

    Reprint requests: Joseph M. Mylotte, MD, CIC, Infectious Diseases, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215.

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    Copyright © 2001 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.