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Original Research: CRITICAL CARE |

Health-care-Associated Bloodstream Infections at Admission to the ICU

Jordi Vallés, MD, PhD; Francisco Alvarez-Lerma, MD; Mercedes Palomar, MD; Armando Blanco, MD; Ana Escoresca, MD; Fernando Armestar, MD; José María Sirvent, MD; Carina Balasini, MD; Rafael Zaragoza, MD; María Marín, MD; the Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine
Author and Funding Information

From the CIBER Enfermedades Respiratorias (Dr Vallés), Hospital Sabadell, Sabadell, Spain; Hospital del Mar (Dr Alvarez-Lerma), Barcelona, Spain; Hospital Vall d’Hebron (Dr Palomar), Barcelona, Spain; Hospital Central de Asturias (Dr Blanco), Oviedo, Spain; Hospital Virgen del Rocío (Dr Escoresca), Sevilla, Spain; Hospital Germans Trías i Pujol (Dr Armestar), Badalona, Spain; Hospital Josep Trueta (Dr Sirvent), Girona, Spain; Hospital Peset (Dr Zaragoza), Valencia, Spain; Hospital Valme (Dr Marín), Sevilla, Spain; and Hospital Interzonal General de Agudos “José de San Martín” (Dr Balasini), La Plata, Argentina.

Correspondence to: Jordi Vallés, MD, PhD, Critical Care Center, Hospital Sabadell, CIBER Enfermedades Respiratorias, Parc Tauli s/n, 08208 Sabadell, Barcelona, Spain; e-mail: jvalles@tauli.cat

A complete list of the study group is located in e-Appendix 1.


Funding/Support: This study was funded by a grant from the Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):810-815. doi:10.1378/chest.10-1715
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Background:  Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU.

Methods:  This work was a multicenter, prospective, observational study of all adult patients with BSI at ICU admission at 27 Spanish hospitals and one Argentine hospital. Cases of BSI were classified as community-acquired BSI (CAB), health-care-associated BSI (HCAB), or hospital-acquired BSI (HAB), and their characteristics were compared.

Results:  Of 726 BSIs, 343 (47.2%) were CABs, 252 (34.7%) were HABs, and 131 (18.0%) were HCABs. Potentially antibiotic-resistant pathogens were more frequently isolated in HABs (34.8%) and HCABs (27.6%) than in CABs (10.3%) (P < .001). Logistic regression analysis revealed that HABs (OR, 4.6; 95% CI, 2.9-7.3), HCABs (OR, 3.1; 95% CI, 1.8-5.4), and BSIs of unknown origin (OR, 1.7; 95% CI, 1.0-2.8) were independently associated with the isolation of potentially antibiotic-resistant pathogens. The incidence of inappropriate treatment was significantly higher in HABs (OR, 3.4; 95% CI, 2.1-5.3) and in HCABs (OR, 1.8; 95% CI, 1.0-3.2) than in CABs.

Conclusions:  One in five BSIs diagnosed at ICU admission is health-care-associated. The incidence of potentially drug-resistant pathogens in HCABs is more similar to that of HABs, and they should be treated as such until culture data are available.


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