Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome

A prospective study of all patients with clinically significant nosocomial bacteremia at one institution from 1994 to 1997 was performed to: (1) descr ibe the epidemiology and microbiology of nosocomial bacteremias; (2) determ ine the crude mortality associated with such infections; and (3) identify i ndependent predictors of mortality. Four hundred four episodes of bacteremi a occurred in 322 patients; the crude in-hospital mortality was 31%. Coagul ase-negative staphylococci, Staphylococcus aureus, and enterococci were the leading pathogens, and intravascular catheters were the mast frequently id entified source. The highest mortality occurred in patients with candidemia (67%). Independent predictors of mortality included evidence of shock at t he time of infection, acquisition of bacteremia in an intensive care unit, a ''Do Not Attempt Resuscitation" order, and the presence of certain comorb id conditions (e.g., malignancy, HIV infection). Because many of these infe ctions may be preventable, education of health care providers and strict ad herence to established infection control practices are critical. (C) 2000 E lsevier Science Inc. All rights reserved.