Healthcare-related bacteraemia admitted to the ICU

Introduction

Bacteraemia developing in patients outside the hospital is categorized as community acquired. Accumulating evidence suggests that healthcare-related bacteraemia (HCRB) are distinct from those that are community acquired.

Methods

A prospective, observational study of all the patients with community-acquired bacteraemia sepsis (CABS) admitted to a tertiary, mixed, 12-bed ICU, at a university hospital, between 1 December 2004 and 30 November 2005. HCRB was defined according to criteria proposed by Friedman and colleagues [1].

Results

Throughout the study period, 160 patients were admitted with CABS; 50 (31%) had HCRB. In the CABS group the main focus of infection was respiratory (41%), intra-abdominal (15%) and endovascular (15%); in the HCRB group respiratory infection was present in 14 (28%) patients, intra-abdominal in 13 (26%) patients and urological in 10 (20%) patients (P = 0.227). The microbiological profile was different between the two groups: in the non-HCRB the main microbiological agents were Gram-positive 57 (63%), versus 34 (37%) Gram-negative. In the HCRB group the Gram-negative dominated the microbiological profile: 26 (65%) versus 34 (37%) (P = 0.003). The ICU crude mortality was different in both groups (52% in HCRB versus 34% in CABS, P = 0.028) and also hospital mortality (60% vs 39%, P = 0.013).

Conclusion

HCRB has a higher crude mortality and a different microbiological profile was shown in the present study. This knowledge should prompt the necessity for early recognition of patients with HCRB that would need a different therapeutic approach.