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Reemergence of Gram-negative Health Care–Associated Bloodstream Infections
Svenja J. Albrecht, MD;
Neil O. Fishman, MD;
Jennifer Kitchen, MD, PhD;
Irving Nachamkin, DrPH, MPH;
Warren B. Bilker, PhD;
Cindy Hoegg, BSN, RN;
Carol Samel, MS, MT;
Stephanie Barbagallo, MBA, MT;
Judy Arentzen, BS, MT;
Ebbing Lautenbach, MD, MPH, MSCE
Arch Intern Med. 2006;166:1289-1294.
Background Primary health care–associated bloodstream infections (PHA-BSIs) affect as many as 350 000 patients in the United States annually. Whereas gram-negative organisms were the leading cause before the 1970s, gram-positive organisms have been the predominant microbial isolates since then.
Methods We identified all PHA-BSIs among adult inpatients in a 625-bed quaternary care hospital from January 1, 1996, through December 31, 2003, and evaluated trends in the microbial etiology, geographic distribution within the institution, and antimicrobial susceptibilities.
Results A total of 3662 PHA-BSIs caused by 4349 bacterial and fungal isolates were identified. From 1999 to 2003, the proportion of PHA-BSIs due to gram-negative organisms increased from 15.9% to 24.1% (P<.001 for trend). This trend was not significantly different across various units of the hospital, and no specific gram-negative species contributed disproportionately to the increase. With few exceptions, there were no significant increases in antimicrobial resistance. The increase in gram-negative organisms was accompanied by a decline in the proportion of PHA-BSIs from coagulase-negative staphylococci (from 33.5% in 1999 to 29.9% in 2003, P = .007) and from Staphylococcus aureus (from 18.8% in 1999 to 11.8% in 2003, P = .004). The proportion of PHA-BSIs from Candida species almost doubled from 5.8% in 1999 to 11.3% in 2003 (P = .002).
Conclusions To our knowledge, this is the first US study to report a reemergence of gram-negative organisms as a cause of PHA-BSIs. This finding does not seem to be related to changes in specific gram-negative organisms or to antimicrobial resistance. If this trend continues, it will have important implications for the management of bloodstream infections.
Author Affiliations: Divisions of Infectious Diseases (Drs Albrecht, Fishman, and Lautenbach) and General Internal Medicine (Dr Kitchen), Department of Medicine, Department of Hospital Epidemiology and Infection Control (Drs Fishman and Lautenbach and Mss Hoegg, Samel, Barbagallo, and Arentzen), Department of Pathology and Laboratory Medicine (Dr Nachamkin), and Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Center for Education and Research on Therapeutics (Drs Bilker and Lautenbach), University of Pennsylvania School of Medicine, Philadelphia.
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