Community-acquired bacteremia at a teaching versus a nonteaching hospital: Impact of acute severity of illness on 30-day mortality

作     者：Mylotte, JM Kahler, L McCann, C 

作者机构：Erie Cty Med Ctr & Labs Dept Med Div Infect Dis Buffalo NY 14215 USA SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA 

出 版 物：《AMERICAN JOURNAL OF INFECTION CONTROL》 (美国传染病控制)

年 卷 期：2001年第29卷第1期

页      面：13-19页

核心收录：

学科分类：12[管理学] 1204[管理学-公共管理] 120402[管理学-社会医学与卫生事业管理(可授管理学、医学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 10[医学] 

主　　题：急性病生理学和长期健康评价 急性病 年龄因素 菌血症/药物疗法 菌血症/微生物学 菌血症/死亡率 交叉感染/药物疗法 交叉感染/微生物学 交叉感染/死亡率 大肠杆菌感染/死亡率 医院死亡率 纽约/流行病学 肺炎 细菌性/死亡率 预后 回顾性研究 疾病严重程度指数 葡萄球菌感染/死亡率 存活率分析 存活率 时间因素 治疗结果 成年人 老年人 老年人 80以上 人类 中年人 

摘      要：Background: Few studies have focused recently on the epidemiology of community-acquired bacteremia (CAB) and there have been few comparisons of CAB in teaching versus nonteaching hospitals. Objectives: To compare the clinical characteristics, acute severity of illness, and 30-day mortality of patients with CAB admitted to a teaching and a nonteaching hospital and to define predictors of 30-day mortality among patients with CAB that would be identifiable at the time of admission to the hospital. Methods: This was a retrospective study of CAB at a reaching hospital (n = 174 episodes) compared to a community nonteaching hospital (n = 74 episodes) during 1995. Data collected included demographic characteristics, underlying diseases, sources of CAB, and antimicrobial therapy. Acute severity of illness on admission was measured by using the acute physiology score component of the Acute Physiology and Chronic Health Evaluation III system (APS APACHE III). Main Outcome Measure: Status, dead or alive, 30 days after admission for CAB. Results: At the nonteaching hospital, patients were older but, on average, significantly less acutely ill (as measured by the admission APS APACHE III score) than were those at the teaching hospital. In contrast, patients with HN infection, posttransplantation, or on hemodialysis were identified only at the teaching hospital. Overall, organisms causing CAB at both hospitals were similar except that Staphylococcus aureus CAB occurred significantly more often at the teaching hospital and Escherichia coli CAB occurred more often at the nonteaching hospital. There was no significant difference in 30-day mortality in patients with CAB between the teaching hospital (19.3%) and the nonteaching hospital (16.7%;P =.63). APS APACHE III score on admission identified episodes of CAB with a low- and a high-risk for 30-day mortality at both hospitals. Independent predictors of 30-day mortality were APACHE III score on admission (P .001) and pneumonia as a s