Four-year prospective evaluation of community-acquired bacteremia: Epidemiology, microbiology, and patient outcome

The objectives of this study were to (1) describe the epidemiology and micr obiology of community-acquired bacteremia; (2) determine the crude mortalit y associated with such infections; and (3) identify independent predictors of mortality. All patients with clinically significant community-acquired b acteremia admitted to a university-affiliated Veterans Affairs medical cent er from January 1994 through December 1997 were evaluated. During the study period, 387 bacteremic episodes occurred in 334 patients. Staphylococcus a ureus, Escherichia coli, and coagulase-negative staphylococci were the most commonly isolated organisms, the most frequent sources were the urinary tr act and intravascular catheters. Approximately 14% of patients died. Patien t characteristics independently associated with increased mortality include d shock (OR 3.7, p = 0.02) and renal failure (OR 4.0, p = 0.003). The risk of death was also higher in those whose source was pneumonia (OR 6.3, p = 0 .03) or an intra-abdominal site (OR 10.7, p = 0.02), or if multiple sources were identified (OR 13.4, p = 0.003). Community-acquired bacteremia is oft en device-related and may be preventable. Strategies that have been success ful in preventing nosocomial device-related bacteremia should be adapted to the outpatient setting. (C) 2001 Elsevier Science Inc. All rights reserved .