BACTEREMIA IN A COMMUNITY AND A UNIVERSITY HOSPITAL

Four hundred and forty-one and 1048 episodes of bacteraemia were prosp ectively surveyed over a period of 18 months in two hospitals, a 450 b ed community hospital and a 900 bed tertiary care urban university hos pital. Incidence of bacteraemia was 2.18 per 1000 hospitalization days (10.1 per 1000 admissions) in the community hospital and 2.64 per 100 0 hospitalization days (12.0 per 1000 admissions (P < 0.004)) in the u niversity hospital. Sixty six and 62% of episodes of bacteraemia were community acquired. The majority of bacteraemic episodes originated on the internal medicine wards of both hospital-46.7% and 58.7% respecti vely; the incidence of bacteraemia in the medical divisions of both ho spitals was 23.1 and 17.5 per 1000 admissions respectively (P < 0.01). Overall mortality rates were 22% and 26.7% respectively. 39.9% and 44 % of all isolates were Gram-positive pathogens. Escherichia coli was t he commonest Gram-negative pathogen in both hospitals, particularly th e community hospital-47.5% vs 32.8% (P < 0.005) of all Gram-negative p athogens, while Pseudomonas spp. were significantly more common in the university hospital-18.5% vs 11.8% (P < 0.02). Non-enterococcal strep tococci were more common in the community hospital while enterococci w ere far more common at the university hospital-15.1% vs 1% of all Gram -positive pathogens (P < 0.05). Staphylococcus epidermidis was more co mmon among the community hospital Gram-positive bacteraemias-31.1% vs 18.6% (P < 0.005). For almost all genera and species, antibiotic resis tance was higher at the university hospital. Twenty nine point four pe r cent of Staphylococcus aureus isolates from the university hospital were methicillin resistant compared to 2.4% at the community hospital (P < 0.005). 29.4% of all Streptococcus pneumoniae isolates at the uni versity hospital were penicillin resistant while no resistance was fou nd at the community hospital. A high resistance rate to ofloxacin was found at the university hospital among S. aureus and Pseudomonas sp. S ources of bacteraemia did not differ significantly between the two hos pitals. In conclusion, although outcome did not differ significantly f or the two hospitals, there were significant differences between blood culture isolates in these two different settings. These differences m ay influence clinical decision-making about antibiotic therapy for pat ients in these hospitals.