Stephanie J Curtis, Sue J Lee, Ben S Cooper, Jan M Bell, Geoffrey W Coombs, Denise A Daley, Allen C Cheng, Denis W Spelman, Anton Y Peleg, Andrew J Stewardson
{"title":"澳大利亚墨尔本一家三级转诊医院中与抗菌素敏感和耐药医院源性血流感染相关的死亡率和住院时间","authors":"Stephanie J Curtis, Sue J Lee, Ben S Cooper, Jan M Bell, Geoffrey W Coombs, Denise A Daley, Allen C Cheng, Denis W Spelman, Anton Y Peleg, Andrew J Stewardson","doi":"10.1093/jacamr/dlaf183","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, <i>Staphylococcus aureus</i>, <i>Enterococcus</i> species and the non-fermenting Gram-negative bacilli (NFGNB), <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter</i> species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models.</p><p><strong>Results: </strong>The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, <i>S. aureus</i> and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9-6.5) and 4.1 days (95% CI: 3.8-4.5) for Enterobacterales, 4.9 days (95% CI: 4.5-5.4) and 3.1 days (95% CI: 2.6-3.6) for enterococci, and 6.3 days (95% CI: 5.3-7.3) and 9.8 days (95% CI: 9.1-10.5) for <i>S. aureus</i>.</p><p><strong>Conclusions: </strong>Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":"7 5","pages":"dlaf183"},"PeriodicalIF":3.3000,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539618/pdf/","citationCount":"0","resultStr":"{\"title\":\"Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia.\",\"authors\":\"Stephanie J Curtis, Sue J Lee, Ben S Cooper, Jan M Bell, Geoffrey W Coombs, Denise A Daley, Allen C Cheng, Denis W Spelman, Anton Y Peleg, Andrew J Stewardson\",\"doi\":\"10.1093/jacamr/dlaf183\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data.</p><p><strong>Methods: </strong>We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, <i>Staphylococcus aureus</i>, <i>Enterococcus</i> species and the non-fermenting Gram-negative bacilli (NFGNB), <i>Pseudomonas aeruginosa</i> and <i>Acinetobacter</i> species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models.</p><p><strong>Results: </strong>The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, <i>S. aureus</i> and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9-6.5) and 4.1 days (95% CI: 3.8-4.5) for Enterobacterales, 4.9 days (95% CI: 4.5-5.4) and 3.1 days (95% CI: 2.6-3.6) for enterococci, and 6.3 days (95% CI: 5.3-7.3) and 9.8 days (95% CI: 9.1-10.5) for <i>S. aureus</i>.</p><p><strong>Conclusions: </strong>Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.</p>\",\"PeriodicalId\":14594,\"journal\":{\"name\":\"JAC-Antimicrobial Resistance\",\"volume\":\"7 5\",\"pages\":\"dlaf183\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-10-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12539618/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAC-Antimicrobial Resistance\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jacamr/dlaf183\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAC-Antimicrobial Resistance","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jacamr/dlaf183","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/10/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia.
Background and objectives: There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data.
Methods: We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models.
Results: The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9-6.5) and 4.1 days (95% CI: 3.8-4.5) for Enterobacterales, 4.9 days (95% CI: 4.5-5.4) and 3.1 days (95% CI: 2.6-3.6) for enterococci, and 6.3 days (95% CI: 5.3-7.3) and 9.8 days (95% CI: 9.1-10.5) for S. aureus.
Conclusions: Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.
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