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National Bloodstream Infection Surveillance in Switzerland 2008–2014: Different Patterns and Trends for University and Community Hospitals

Published online by Cambridge University Press:  28 June 2016

Niccolò Buetti ,
Jonas Marschall ,
Andrew Atkinson ,
Andreas Kronenberg  and
Swiss Centre for Antibiotic Resistance (ANRESIS)
Niccolò Buetti
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
Jonas Marschall*
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
Andrew Atkinson
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
Andreas Kronenberg
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
*
Address correspondence to Jonas Marschall, MD, Freiburgstrasse 4, 3010 Bern, Switzerland ([email protected]).
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Abstract

OBJECTIVE

To characterize the epidemiology of bloodstream infections in Switzerland, comparing selected pathogens in community and university hospitals.

DESIGN

Observational, retrospective, multicenter laboratory surveillance study.

METHODS

Data on bloodstream infections from 2008 through 2014 were obtained from the Swiss infection surveillance system, which is part of the Swiss Centre for Antibiotic Resistance (ANRESIS). We compared pathogen prevalences across 26 acute care hospitals. A subanalysis for community-acquired and hospital-acquired bloodstream infections in community and university hospitals was performed.

RESULTS

A total of 42,802 bloodstream infection episodes were analyzed. The most common etiologies were Escherichia coli (28.3%), Staphylococcus aureus (12.4%), and polymicrobial bloodstream infections (11.4%). The proportion of E. coli increased from 27.5% in 2008 to 29.6% in 2014 (P = .04). E. coli and S. aureus were more commonly reported in community than university hospitals (34.3% vs 22.7%, P<.001 and 13.9% vs 11.1%, P<.001, respectively). Fifty percent of episodes were community-acquired, with E. coli again being more common in community hospitals (41.0% vs 32.4%, P<.001). The proportion of E. coli in community-acquired bloodstream infections increased in community hospitals only. Community-acquired polymicrobial infections (9.9% vs 5.6%, P<.001) and community-acquired coagulase-negative staphylococci (6.7% vs 3.4%, P<0.001) were more prevalent in university hospitals.

CONCLUSIONS

The role of E. coli as predominant pathogen in bloodstream infections has become more pronounced. There are distinct patterns in community and university hospitals, potentially influencing empirical antibiotic treatment.

Infect Control Hosp Epidemiol 2016;37:1060–1067

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1060 - 1067
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Members of ANRESIS are listed at the end of the text.

References

REFERENCES

1. Laupland, KB, Gregson, DB, Flemons, WW, Hawkins, D, Ross, T, Church, DL. Burden of community-onset bloodstream infection: a population-based assessment. Epidemiol Infect 2007;135:1037–1042.CrossRefGoogle ScholarPubMed
2. Pien, BC, Sundaram, P, Raoof, N, et al. The clinical and prognostic importance of positive blood cultures in adults. Am J Med 2010;123:819–828.Google Scholar
3. Goto, M, Al-Hasan, MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013;19:501–509.Google Scholar
4. Martin, GS, Mannino, DM, Eaton, S, Moss, M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546–1554.CrossRefGoogle ScholarPubMed
5. Wilson, J, Elgohari, S, Livermore, DM, et al. Trends among pathogens reported as causing bacteraemia in England, 2004-2008. Clin Microbiol Infect 2011;17:451–458.Google Scholar
6. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2013. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2014.Google Scholar
7. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791–797.CrossRefGoogle ScholarPubMed
8. Valles, J, Calbo, E, Anoro, E, et al. Bloodstream infections in adults: importance of healthcare-associated infections. J Infect 2008;56:27–34.Google Scholar
9. Rodriguez-Bano, J, Lopez-Prieto, MD, Portillo, MM, et al. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect 2010;16:1408–1413.CrossRefGoogle ScholarPubMed
10. Mylotte, JM, Kahler, L, McCann, C. Community-acquired bacteremia at a teaching versus a nonteaching hospital: impact of acute severity of illness on 30-day mortality. Am J Infect Control 2001;29:13–19.Google Scholar
11. Elhanan, G, Raz, R, Pitlik, SD, et al. Bacteraemia in a community and a university hospital. J Antimicrob Chemother 1995;36:681–695.CrossRefGoogle Scholar
12. ANRESIS. Swiss Centre for Antibiotic Resistance. ANRESIS website. www.anresis.ch. Accessed June 4, 2016.Google Scholar
13. Bundesamt für Gesundheit (BAG), (Federal Office of Public Health),Spitalstatistiken. [Hospital statistics]. http://www.bag.admin.ch/index.html. Published 2014. Accessed June 4, 2016.Google Scholar
14. De Pietro, C, Camenzind, P, Sturny, I, et al. Switzerland: Health System Review. Health Syst Transit 2015;17:1–288.Google Scholar
15. Clinical and Laboratory Standards Institute (CLSI). CLSI website. http://www.clsi.org. Accessed April 1, 2016.Google Scholar
16. Vollset, SE. Confidence intervals for a binomial proportion. Stat Med 1993;12:809–824.Google Scholar
17. R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2015.Google Scholar
18. Skogberg, K, Lyytikainen, O, Ollgren, J, Nuorti, JP, Ruutu, P. Population-based burden of bloodstream infections in Finland. Clin Microbiol Infect 2012;18:E170–E176.Google Scholar
19. de Kraker, ME, Jarlier, V, Monen, JC, Heuer, OE, van de Sande, N, Grundmann, H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;19:860–868.Google Scholar
20. van der Mee-Marquet, NL, Blanc, DS, Gbaguidi-Haore, H, et al. Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly. Front Microbiol 2015;6:646.Google Scholar
21. Hoenigl, M, Wagner, J, Raggam, RB, et al. Characteristics of hospital-acquired and community-onset blood stream infections, South-East Austria. PLOS ONE 2014;9:e104702.CrossRefGoogle ScholarPubMed
22. Kronenberg, A, Hilty, M, Endimiani, A, Muhlemann, K. Temporal trends of extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in in- and outpatients in Switzerland, 2004 to 2011. Euro Surveill 2013;18.CrossRefGoogle ScholarPubMed
23. Laupland, KB. Incidence of bloodstream infection: a review of population-based studies. Clin Microbiol Infect 2013;19:492–500.Google Scholar
24. Nielsen, SL, Pedersen, C, Jensen, TG, Gradel, KO, Kolmos, HJ, Lassen, AT. Decreasing incidence rates of bacteremia: a 9-year population-based study. J Infect 2014;69:51–59.Google Scholar
25. Mostofsky, E, Lipsitch, M, Regev-Yochay, G. Is methicillin-resistant Staphylococcus aureus replacing methicillin-susceptible S. aureus? J Antimicrob Chemother 2011;66:2199–2214.CrossRefGoogle ScholarPubMed
26. Eggimann, P, Pittet, D. Nonantibibiotic measures for the prevention of gram-positive infections. Clin Microbiol Infect 2001;7:91–99.Google Scholar
27. David, MZ, Daum, RS, Bayer, AS, et al. Staphylococcus aureus bacteremia at 5 US academic medical centers, 2008-2011: significant geographic variation in community-onset infections. Clin Infect Dis 2014;59:798–807.CrossRefGoogle ScholarPubMed
28. Pavlaki, M, Drimousis, P, Adamis, G, et al. Polymicrobial bloodstream infections: epidemiology and impact on mortality. J Glob Antimicrob Resist 2013:207–212.Google Scholar
29. Luzzaro, F, Ortisi, G, Larosa, M, Drago, M, Brigante, G, Gesu, G. Prevalence and epidemiology of microbial pathogens causing bloodstream infections: results of the OASIS multicenter study. Diagn Microbiol Infect Dis 2011;69:363–369.Google Scholar
30. Lin, JN, Lai, CH, Chen, YH, et al. Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: a matched case-control study. Acad Emerg Med 2010;17:1072–1079.Google Scholar
31. Bouza, E, Burillo, A, Munoz, P, Guinea, J, Marin, M, Rodriguez-Creixems, M. Mixed bloodstream infections involving bacteria and Candida spp. J Antimicrob Chemother 2013;68:1881–1888.Google Scholar
32. Chowers, MY, Gottesman, B, Paul, M, Weinberger, M, Pitlik, S, Leibovici, L. Persistent bacteremia in the absence of defined intravascular foci: clinical significance and risk factors. Eur J Clin Microbiol Infect Dis 2003;22:592–596.Google Scholar
33. Sancho, S, Artero, A, Zaragoza, R, Camarena, JJ, Gonzalez, R, Nogueira, JM. Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients. Eur J Clin Microbiol Infect Dis 2012;31:1791–1796.Google Scholar
34. Hofmarcher, MM, Quentin, W. Austria: health system review. Health Systems in Transition 2013;15:1–292.Google ScholarPubMed
35. Anell, A, Glenngard, AH, Merkur, S. Sweden health system review. Health Systems in Transition 2012;14:1–159.Google Scholar
36. Rice, T, Rosenau, P, Unruh, LY, Barnes, AJ, Saltman, RB, van Ginneken, E. United States of America: health system review. Health Systems in Transition 2013;15:1–431.Google Scholar
37. Anderson, DJ, Moehring, RW, Sloane, R, et al. Bloodstream infections in community hospitals in the 21st century: a multicenter cohort study. PLOS ONE 2014;9:e91713.CrossRefGoogle ScholarPubMed
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