Bacteremia in Previously Hospitalized Patients

Prolonged Effect From Previous Hospitalization and Risk Factors for Antimicrobial-Resistant Bacterial Infections

Shey Ying Chen, Grace Hui Min Wu, Shan Chwen Chang, Po Ren Hsueh, Wen Chu Chiang, Chien Chang Lee, Matthew Huei Ming Ma, Chien Ching Hung, Yee Chun Chen, Chan Ping Su, Kuang Chau Tsai, Tony Hsiu Hsi Chen, Shyr Chyr Chen, Wen Jone Chen

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Study objective: Patients who came from the community but were recently discharged from the hospital have a higher risk of contracting antimicrobial-resistant bacterial infections. Our objectives are to determine the time from previous hospital discharge that affects subsequent antimicrobial susceptibility pattern and risk factors for antimicrobial-resistant infection in bacteremia in recently discharged patients. Methods: Excluding patients of hospital-acquired, patients with regular health care-associated exposure, and patients whose previous hospitalization was not at our hospital, a total of 789 nonduplicated bacteremia episodes from community adult patients were enrolled in a 1-year study period. Antimicrobial-resistant bacteria, including multidrug-resistant Gram-negative bacilli, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci causing bacteremia, were logistically analyzed according to different posthospitalization periods (3 to 90 days, 91 to 180 days, 181 to 360 days, and no hospitalization in the past 360 days) to identify the independent effect from previous hospitalization on subsequent antimicrobial-resistant bacteremia. Results: Of the 789 bacteremia patients, the proportion of antimicrobial-resistant bacteremia is 14.6% (95% confidence interval [CI] 9.8% to 19.4%) for 3 to 90 days, 9.6% (95% CI 1.6% to 17.6%) for 91 to 180 days, and 6.4% (95% CI 0% to 13.4%) for 181 to 360 days since last hospitalization and 1.0% (95% CI 0.1% to 1.9%) for no hospitalization within the last 360 days. Risk of antimicrobial-resistant bacteremia decreased monthly after discharge by an odds ratio of 0.83 (95% CI 0.76 to 0.90) (P<.01). Previous carriage of antimicrobial-resistant bacteria in the past 360 days and previous stay at ICU in the past 180 days were independent risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients. Conclusion: Previous hospitalization affects the antimicrobial susceptibility of subsequent bacteremia up to 360 days after hospital discharge. Presence of risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients may help emergency physicians in selecting empirical antimicrobial agents and prompting infection control precautions.

Original languageEnglish
Pages (from-to)639-646
Number of pages8
JournalAnnals of Emergency Medicine
Volume51
Issue number5
DOIs
Publication statusPublished - May 1 2008
Externally publishedYes

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Bacteremia
Bacterial Infections
Hospitalization
Confidence Intervals
Bacteria
Methicillin-Resistant Staphylococcus aureus
Infection Control
Anti-Infective Agents
Bacillus
Emergencies
Odds Ratio
Delivery of Health Care
Physicians

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Bacteremia in Previously Hospitalized Patients : Prolonged Effect From Previous Hospitalization and Risk Factors for Antimicrobial-Resistant Bacterial Infections. / Chen, Shey Ying; Wu, Grace Hui Min; Chang, Shan Chwen; Hsueh, Po Ren; Chiang, Wen Chu; Lee, Chien Chang; Ma, Matthew Huei Ming; Hung, Chien Ching; Chen, Yee Chun; Su, Chan Ping; Tsai, Kuang Chau; Chen, Tony Hsiu Hsi; Chen, Shyr Chyr; Chen, Wen Jone.

In: Annals of Emergency Medicine, Vol. 51, No. 5, 01.05.2008, p. 639-646.

Research output: Contribution to journalArticle

Chen, SY, Wu, GHM, Chang, SC, Hsueh, PR, Chiang, WC, Lee, CC, Ma, MHM, Hung, CC, Chen, YC, Su, CP, Tsai, KC, Chen, THH, Chen, SC & Chen, WJ 2008, 'Bacteremia in Previously Hospitalized Patients: Prolonged Effect From Previous Hospitalization and Risk Factors for Antimicrobial-Resistant Bacterial Infections', Annals of Emergency Medicine, vol. 51, no. 5, pp. 639-646. https://doi.org/10.1016/j.annemergmed.2007.12.022
Chen, Shey Ying ; Wu, Grace Hui Min ; Chang, Shan Chwen ; Hsueh, Po Ren ; Chiang, Wen Chu ; Lee, Chien Chang ; Ma, Matthew Huei Ming ; Hung, Chien Ching ; Chen, Yee Chun ; Su, Chan Ping ; Tsai, Kuang Chau ; Chen, Tony Hsiu Hsi ; Chen, Shyr Chyr ; Chen, Wen Jone. / Bacteremia in Previously Hospitalized Patients : Prolonged Effect From Previous Hospitalization and Risk Factors for Antimicrobial-Resistant Bacterial Infections. In: Annals of Emergency Medicine. 2008 ; Vol. 51, No. 5. pp. 639-646.
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abstract = "Study objective: Patients who came from the community but were recently discharged from the hospital have a higher risk of contracting antimicrobial-resistant bacterial infections. Our objectives are to determine the time from previous hospital discharge that affects subsequent antimicrobial susceptibility pattern and risk factors for antimicrobial-resistant infection in bacteremia in recently discharged patients. Methods: Excluding patients of hospital-acquired, patients with regular health care-associated exposure, and patients whose previous hospitalization was not at our hospital, a total of 789 nonduplicated bacteremia episodes from community adult patients were enrolled in a 1-year study period. Antimicrobial-resistant bacteria, including multidrug-resistant Gram-negative bacilli, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci causing bacteremia, were logistically analyzed according to different posthospitalization periods (3 to 90 days, 91 to 180 days, 181 to 360 days, and no hospitalization in the past 360 days) to identify the independent effect from previous hospitalization on subsequent antimicrobial-resistant bacteremia. Results: Of the 789 bacteremia patients, the proportion of antimicrobial-resistant bacteremia is 14.6{\%} (95{\%} confidence interval [CI] 9.8{\%} to 19.4{\%}) for 3 to 90 days, 9.6{\%} (95{\%} CI 1.6{\%} to 17.6{\%}) for 91 to 180 days, and 6.4{\%} (95{\%} CI 0{\%} to 13.4{\%}) for 181 to 360 days since last hospitalization and 1.0{\%} (95{\%} CI 0.1{\%} to 1.9{\%}) for no hospitalization within the last 360 days. Risk of antimicrobial-resistant bacteremia decreased monthly after discharge by an odds ratio of 0.83 (95{\%} CI 0.76 to 0.90) (P<.01). Previous carriage of antimicrobial-resistant bacteria in the past 360 days and previous stay at ICU in the past 180 days were independent risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients. Conclusion: Previous hospitalization affects the antimicrobial susceptibility of subsequent bacteremia up to 360 days after hospital discharge. Presence of risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients may help emergency physicians in selecting empirical antimicrobial agents and prompting infection control precautions.",
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AU - Chang, Shan Chwen

AU - Hsueh, Po Ren

AU - Chiang, Wen Chu

AU - Lee, Chien Chang

AU - Ma, Matthew Huei Ming

AU - Hung, Chien Ching

AU - Chen, Yee Chun

AU - Su, Chan Ping

AU - Tsai, Kuang Chau

AU - Chen, Tony Hsiu Hsi

AU - Chen, Shyr Chyr

AU - Chen, Wen Jone

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N2 - Study objective: Patients who came from the community but were recently discharged from the hospital have a higher risk of contracting antimicrobial-resistant bacterial infections. Our objectives are to determine the time from previous hospital discharge that affects subsequent antimicrobial susceptibility pattern and risk factors for antimicrobial-resistant infection in bacteremia in recently discharged patients. Methods: Excluding patients of hospital-acquired, patients with regular health care-associated exposure, and patients whose previous hospitalization was not at our hospital, a total of 789 nonduplicated bacteremia episodes from community adult patients were enrolled in a 1-year study period. Antimicrobial-resistant bacteria, including multidrug-resistant Gram-negative bacilli, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci causing bacteremia, were logistically analyzed according to different posthospitalization periods (3 to 90 days, 91 to 180 days, 181 to 360 days, and no hospitalization in the past 360 days) to identify the independent effect from previous hospitalization on subsequent antimicrobial-resistant bacteremia. Results: Of the 789 bacteremia patients, the proportion of antimicrobial-resistant bacteremia is 14.6% (95% confidence interval [CI] 9.8% to 19.4%) for 3 to 90 days, 9.6% (95% CI 1.6% to 17.6%) for 91 to 180 days, and 6.4% (95% CI 0% to 13.4%) for 181 to 360 days since last hospitalization and 1.0% (95% CI 0.1% to 1.9%) for no hospitalization within the last 360 days. Risk of antimicrobial-resistant bacteremia decreased monthly after discharge by an odds ratio of 0.83 (95% CI 0.76 to 0.90) (P<.01). Previous carriage of antimicrobial-resistant bacteria in the past 360 days and previous stay at ICU in the past 180 days were independent risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients. Conclusion: Previous hospitalization affects the antimicrobial susceptibility of subsequent bacteremia up to 360 days after hospital discharge. Presence of risk factors for antimicrobial-resistant bacteremia in previously hospitalized patients may help emergency physicians in selecting empirical antimicrobial agents and prompting infection control precautions.

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