The placement of central venous catheters and hemodialysis treatment were found to be the most prominent risk factors among patients who developed hospital-acquired bacteremia (HAB). These findings, from a prospective study, were published in Infectious Diseases.
Between October 2019 and 2020, researchers conducted a study among patients hospitalized at a single tertiary hospital in Denmark to assess risk factors among those who developed HAB. The researchers identified a total of 115 patients with HAB and performed matched incidence density sampling to match them against 230 healthy controls on the basis of sex and age.
Among 115 patients with HAB and 229 healthy controls, the median age was 72 (IQR, 58-76) and 71 (IQR, 61-96) years, 34% and 34% were women, 58% and 39% had decreased Charlson Comorbidity Index scores, 15% and 6% had hematologic cancer, and 13% and 10% had metastatic cancer, respectively.
The researchers found that HAB occurred at a rate of 5.48 per 10,000 risk days, and the most common pathogens involved were Enterococcus faecium (n=20), Escherichia coli (n=16), Staphylococcus aureus (n=14), polymicrobial (n=7), Pseudomonas aeruginosa (n=7), S epidermidis (n=7), Klebsiella pneumoniae (n=6), K oxytoca (n=6), Candida albicans (n=5), and miscellaneous pathogens (n=27). Of note, none of the E faecium pathogens isolated from patients with HAB were resistant to vancomycin treatment.
The researchers found that an increased risk for HAB was associated with the placement of central venous catheters (adjusted odds ratio [aOR], 3.46; 95% CI, 1.92-6.23) and hemodialysis (aOR, 5.05; 95% CI, 1.41-18.06). In addition, the risk for HAB was increased among patients who received immunosuppressive treatment, including chemotherapy, within 30 days of initial hospitalization (OR, 1.82; 95% CI, 1.10-3.02). However, the risk for HAB among these patients was attenuated after adjustments were made for length of hospital stay, urgency of admission, and Charlson Comorbidity Index scores (aOR, 1.72; 95% CI, 1.00-2.96).
Although most of the proposed risk factors showed an increased risk for HAB, the researchers found no statistically significant associations between an increased risk for HAB and arterial catheters (aOR, 1.04; 95% CI, 0.56-1.94), thoracic drain and catheters (aOR, 1.18; 95% CI, 0.51-2.73), or abdominal procedures (aOR, 1.26; 95% CI, 0.09-1.04).
Limitations of this study included its small sample, observational design, and heterogeneity among the assessed risk factors for HAB. In addition, the Danish government temporarily suspended elective surgical procedures and outpatient visits due to the COVID-19 pandemic, which may have biased the results.
The researchers concluded that additional studies are needed to “…provide the basis for ideas and solutions to combat HAB and [other] hospital-acquired infections.”
Disclosure: One author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Mortensen VH, Søgaard M, Kristensen B, Mygind LH, Schønheyder HC. Risk factors for hospital-acquired bacteraemia – an explorative case–control study of hospital interventions. Infect Dis. 2021;1-8. doi:10.1080/23744235.2021.1994153