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A Population-Based Study in Olmsted County, Minnesota

Daniel Z. Uslan, MD; Sarah J. Crane, MD; James M. Steckelberg, MD; Franklin R. Cockerill III, MD; Jennifer L. St. Sauver, PhD; Walter R. Wilson, MD; Larry M. Baddour, MD

Arch Intern Med. 2007;167(8):834-839.

Background  Despite increasing concerns about antimicrobial resistance and emerging pathogens among blood culture isolates, contemporary population-based data on the age- and sex-specific incidence of bloodstream infections (BSIs) are limited.

Methods  Retrospective, population-based, cohort study of all residents of Olmsted County, Minnesota, with a BSI between January 1, 2003, and December 31, 2005. The medical record linkage system of the Rochester Epidemiology Project and microbiology records were used to identify incident cases.

Results  A total of 1051 unique patients with positive blood culture results were identified; 401 (38.2%) were classified as contaminated. Of 650 patients with cultures deemed clinically relevant, the mean ± SD age was 63.1 ± 23.1 years, and 52.5% were male. The most common organisms identified were Escherichia coli (in 163 patients with BSIs [25.1%]) and Staphylococcus aureus (in 108 patients with BSIs [16.6%]). Nosocomial BSIs were more common in males than females (23.8% vs 13.9%; P = .002). The age-adjusted incidence rate of BSI was 156 per 100 000 person-years for females and 237 per 100 000 person-years for males (P<.001), with an age- and sex-adjusted rate of 189 per 100 000 person-years. Rates of BSI due to gram-positive cocci were 64 per 100 000 person-years for females and 133 per 100 000 person-years for males (P<.001); gram-negative bacillus BSI rates (85/100 000 person-years for females and 79/100 000 person-years for males) were not significantly different between sexes (P = .79). The rate of S aureus BSI was 23 per 100 000 person-years for females and 46 per 100 000 person-years for males (P = .005).

Conclusions  There are significant differences in the age and sex distribution of organisms among patients with BSIs. The incidence of BSI increases sharply with increasing age and is significantly higher in males, mainly because of nosocomial organisms, including S aureus.

Author Affiliations: Divisions of Infectious Diseases (Drs Uslan, Steckelberg, Wilson, and Baddour) and Primary Care Internal Medicine (Dr Crane), Department of Medicine, Division of Microbiology, Department of Pathology (Dr Cockerill), and Department of Health Sciences Research (Dr St. Sauver), Mayo Clinic College of Medicine, Rochester, Minn. Dr Uslan is now with the Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, Calif.