Background
Methods
Study design and data collection
Study definitions
Data entry and statistical analysis
Results
Study population’s demographics
Total | Community acquired BSI | Hospital acquired BSI | |
---|---|---|---|
N = 477 |
N = 400 |
N = 77 | |
n (%) |
n (%) | ||
Age – median (IQR) | 48 (36–60) | 48 (36–60) | 50 (32–60) |
Female sex | 132 (27.7%) | 122 (30.6%) | 10 (13%) |
Any ICU admission during NHTD hospitalisation | 245 (51.4%) | 190 (47.5%) | 55 (71.4%) |
Any history of medical condition | 142 (29.8%) | 109 (27.3%) | 33 (42.9%) |
Liver disease | 68 (14.3%) | 54 (13.5%) | 14 (18.2) |
Diabetes | 34 (7.1%) | 25 (6.3%) | 9 (11.7%) |
Moderate or severe renal disease | 9 (1.9%) | 6 (1.5%) | 3(3.9%) |
HIV infection | 30 (6.3%) | 21 (5.3%) | 9 (11.7%) |
Other morbidity | 10 (2.1%) | 8 (2%) | 2 (2.6%) |
Long-term corticosteroid use | 8 (1.7%) | 7 (1.8%) | 1 (1.3%) |
Self-report alcoholism | 67(14%) | 56 (14%) | 11 (14.3%) |
Intravenous drug use | 23 (4.8%) | 17 (4.3%) | 6 (7.8%) |
Aetiology of bloodstream infections
Analysis of microbiological dataset
Pathogen | All patients | Sampled clinical cases | |||
---|---|---|---|---|---|
Total | CABSI | HABSI | pg
| ||
N = 738 |
N = 477 |
N = 400 |
N = 77 | ||
Enterobacteriaceae | 345 (46.7%) | 245 (51.4%) | 200 (50%) | 45 (58.4%) | 0.213 |
Klebsiella pneumoniae
| 129 (17.5%) | 110 (23.1%) | 88 (22%) | 22 (28.6%) | 0.237d
|
Escherichia coli
| 128 (17.3%) | 73 (15.3%) | 64 (16%) | 9 (11.7%) | 0.391 |
Salmonella enterica | 45 (6.1%) | 30 (6.3%) | 24 (6%) | 6 (7.8%) | 0.606 |
serovar Typhi | 10 (1.4%) | 4 (0.8%) | 4 (1.00%) | 0 | 1 |
non-typhi Salmonella | 35 (4.7%) | 26 (5.5%) | 20 (5%) | 6 (7.8%) | 0.407 |
Serratia marcescens
| 16 (2.2%) | 12 (2.5%) | 9 (2.3%) | 3 (3.9%) | 0.421 |
Enterobacter species | 16 (2.2%) | 12 (2.5%) | 8 (2.0%) | 4 (5.2%) | 0.112 |
Other Enterobacteriaceae speciesa
| 11 (1.5%) | 8 (1.7%) | 7 (1.8%) | 1 (1.3%) | 1 |
Non-Enterobacteriacae | 156 (21.1%) | 99 (20.8%) | 78 (19.5%) | 21 (27.3%) | 0.127 |
Stenotrophomonas maltophilia
| 71 (9.6%) | 47 (9.9%) | 39 (9.8%) | 8 (10.4%) | 0.836 |
Aeromonas species | 34 (4.6%) | 14 (2.9%) | 12 (3.0%) | 2 (2.6%) | 1 |
Burkholderia pseudomallei
| 15 (2.0%) | 13 (2.7%) | 13 (3.3%) | 0 | |
Pseudomonas aeruginosa
| 16 (2.2%) | 13 (2.7%) | 9 (2.3%) | 4 (5.2%) | 0.240 |
Acinetobacter speciesb
| 16 (2.2%) | 10 (2.1%) | 3 (0.8%) | 7 (9.1%) | <0.001 |
Other gram-negative bacteria
c
| 4 (0.5%) | 2 (0.4%) | 2 (0.5%) | 0 | 1 |
Gram-positive isolates | 229 (31.0%) | 126 (26.4%) | 115 (28.8%) | 11 (14.3%) | 0.007 |
Staphylococcus aureus
| 110 (14.9%) | 41 (8.6%) | 34 (8.5%) | 7 (9.1%) | 0.826 |
Streptococcus suis
| 56 (7.6%) | 43 (9.0%) | 43 (10.8%) | 0 | - |
Streptococcus species | 37 (4.9%) | 23 (4.8%) | 21 (5.3%) | 2 (2.6%) | 0.559 |
S. pneumoniae
| 7 (0.9%) | 5 (1.0%) | 4 (1.0%) | 1 (1.3%) | 0.587 |
S. viridans groupd
| 21 (2.8%) | 11 (2.3%)b
| 10 (2.5%) | 1 (1.3%) | 1 |
Beta-hemolytic streptococci
| 9 (1.2%) | 7 (1.5%) | 7 (1.8%) | 0 | 0.604 |
Enterococcus species | 14 (1.9%) | 12 (2.5%) | 10 (2.5%) | 2 (2.6%) | 1 |
Other gram-positive bacteria
e
| 12 (1.6%) | 7 (1.5%) | 7 (1.8%) | 0 | 0.604 |
Polymicrobialf
| 8 (1.1%) | 7 (1.5%) | 7 (1.8%) | 0 | 0.604 |
Resistance | All isolates | Sampled clinical cases | |||
---|---|---|---|---|---|
Total | CABSI | HABSI |
P value a
| ||
Any extended spectrum cephalosporin | 19/133 (14.3%) | 13/112 (11.6%) | 8/90 (8.9%) | 5/22 (22.7%) | 0.128 |
ESBL production | 15/122 (12.3%) | 9/101 (8.9%) | 5/82 (6.1%) | 4/19 (21.1%) | 0.062 |
Others | 4/133 (3.0%) | 4/112 (3.6%) | 3/90 (3.3%) | 1/22 (4.5%) | 1 |
Any carbapenem | 1/131 (0.8%) | 1/109 (0.9%) | 0/89 (0%) | 1/20 (5%) | 0.183 |
Any aminoglycoside | 17/131 (13.0%) | 13/109 (11.9%) | 9/89 (10.1%) | 4/20 (20%) | 0.252 |
Any fluoroquinolone | 11/131 (8.4%) | 8/109 (7.3%) | 4/89 (4.5%) | 4/20 (20%) | 0.036 |
Co-trimoxazole | 24/124 (19.4%) | 19/102 (18.6%) | 14/84 (16.7%) | 5/18 (27.8%) | 0.318 |
Resistance | All isolates | Sampled clinical cases | |||
---|---|---|---|---|---|
Total | CABSI | HABSI |
P valuea
| ||
Any extended spectrum cephalosporin | 72/131 (55.0%) | 45/74 (60.8%) | 39/65 (60%) | 6/9 (66.7%) | 1 |
ESBL production | 50/111 (45%) | 33/61 (54.1%) | 28/52 (53.8%) | 5/9 (55.6%) | 1 |
Others | 22/131 (16.8%) | 12/74 (16.2%) | 11/65 (16.9%) | 1/9 (11.1%) | 1 |
Any carbapenem | 1/130 (0.8%) | 0/73 (0.0%) | 0/64 (0.0%) | 0/9 (0.0%) | - |
Any aminoglycoside | 30/129 (23.3%) | 15/73 (20.5%) | 14/64 (21.9%) | 1/9 (11.1%) | 0.675 |
Any fluoroquinolone | 41/129 (31.8%) | 26/72 (36.1%) | 22/63 (34.9%) | 4/9 (44.4%) | 0.714 |
Cotrimoxazole | 62/90 (68.9%) | 27/38 (71.1%) | 24/33 (72.7%) | 3/5 (60.0%) | 0.615 |
Fosfomycin | 1/52 (1.9%) | 1/44 (2.3%) | 1/38 (2.6%) | 0/6 (0%) | - |
Susceptibility | All isolates | Sampled clinical cases | |||
---|---|---|---|---|---|
Total | CABSI | HABSI |
P value a
| ||
Methicillin (MRSA) | 40/108 (37%) | 12/38 (31.6%) | 12/31 (38.7%) | 0/7 (0%) | 0.074 |
Erythromycin | 39/72 (54.2%) | 11/23 (47.8%) | 10/18 (55.6%) | 1/5 (20%) | 0.317 |
Clindamycin | 56/109 (51.4%) | 21/40 (52.5%) | 18/23 (54.5%) | 3/7 (42.9%) | 0.689 |
Chloramphenicol | 35/105 (33.3%) | 14/38 (36.8%) | 11/31 (35.5%) | 3/7 (42.9%) | 1 |
Gentamicin | 18/76 (23.7%) | 9/26 (34.6%) | 7/21 (33.3%) | 2/5 (40%) | 1 |
Ciprofloxacin | 19/99 (19.2%) | 7/33 (21.2%) | 6/28 (21.4%) | 1/5(20%) | 1 |
Levofloxacin | 18/103 (17.5%) | 9/40 (22.5%) | 6/13 (18.2%) | 3/7 (42.9%) | 0.316 |
Co-trimoxazole | 8/62 (12.9%) | 5/28(17.9%) | 4/21 (19%) | 1/7 (14.3%) | 1 |
Rifampicin | 10/95 (10.5%) | 6/33 (18.2%) | 5/27 (18.5%) | 1/6 (16.7%) | 1 |
Vancomycinb
| 0/63 (0%) | - | - | - | - |
Analysis of the clinical dataset
Case fatality of bloodstream infection
Variable | Hazard ratio (95% CI)a
|
P-valueb
|
---|---|---|
Gender (male/female) | 1.347 (.857–2.115) | 0.196 |
Age (1-yr. increment) | 1.008 (0.998–1.01) | 0.118 |
Aetiology of BSI (gram-positive bacterial infection as reference) | ||
Enterobacteriaceae infections | 2.485 (1.546–3.994) | <0.001 |
Non Enterobacteriaceae Gram-negative infections | 1.931 (1.063–3.50) | 0.031 |
Acquisition of infection (CABSI as reference) | 1.006 (0.633–0.399) | 0.053 |
Any co-morbidities | 1.467 (1.017–2.114) | 0.040 |
Referring from another hospital | 2.049 (1.411–2.975) | <0.001 |