Health Care–Associated Bloodstream Infections in Adults: A Reason To Change the Accepted Definition of Community-Acquired Infections

作者：N. Deborah Friedman, Keith S. Kaye, Jason E. Stout, Sarah A. McGarry, Sharon L. Trivette, Jane P. Briggs, Wanda Lamm, Connie Clark, Jennifer MacFarquhar, Aaron L. Walton, L. Barth Reller, Daniel J. Sexton · 发表于：Annals of Internal Medicine · 年份：2002 · DOI：10.7326/0003-4819-137-10-200211190-00007 · 被引用次数：1685 · 研究领域：Nosocomial Infections in ICU、Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria

BACKGROUND: Bloodstream infections occurring in persons residing in the community, regardless of whether those persons have been receiving health care in an outpatient facility, have traditionally been categorized as community-acquired infections. OBJECTIVE: To develop a new classification scheme for bloodstream infections that distinguishes among community-acquired, health care-associated, and nosocomial infections. DESIGN: Prospective observational study. SETTING: One academic medical center and two community hospitals. PATIENTS: All adult patients admitted to the hospital with bloodstream infection. MEASUREMENTS: Demographic characteristics, living arrangements before hospitalization, comorbid medical conditions, factors predisposing to bloodstream infection, date of hospitalization, dates and number of positive blood cultures, results of microbiological susceptibility testing, dates of hospital discharge or death, and mortality rates at 3 to 6 months of follow-up. RESULTS: 504 patients with bloodstream infections were enrolled; 143 (28%) had community-acquired bloodstream infections, 186 (37%) had health care-associated bloodstream infections, and 175 (35%) had nosocomial bloodstream infections. Of the 186 patients with health care-associated bloodstream infection, 29 resided in a nursing home, 64 were receiving home health care, 78 were receiving intravenous or intravascular therapy at home or in a clinic, and 117 had been hospitalized in the 90 days before their bloodst...