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    Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study.

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    24
    Author
    Lim, CJ; Cheng, AC; Kong, DCM; Peleg, AY
    Date
    2014-03-04
    Source Title
    BMC Infectious Diseases
    Publisher
    Springer Science and Business Media LLC
    University of Melbourne Author/s
    Cheng, Allen
    Affiliation
    Microbiology and Immunology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Lim, C. J., Cheng, A. C., Kong, D. C. M. & Peleg, A. Y. (2014). Community-onset bloodstream infection with multidrug-resistant organisms: a matched case-control study.. BMC Infect Dis, 14 (1), pp.126-. https://doi.org/10.1186/1471-2334-14-126.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/259622
    DOI
    10.1186/1471-2334-14-126
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975842
    Abstract
    BACKGROUND: Multidrug-resistant (MDR) organisms have been increasingly reported at hospital admission. Recognising the magnitude, trend and predictors for MDR organisms in community-onset bloodstream infections (COBSI) is crucial for guiding empiric antibiotic prescribing. METHODS: Positive blood culture isolates recovered from patients presenting to the emergency department during a ten-year period (1st Jan 2002-31st Dec 2011) were assessed. Trend analyses of MDR organisms were performed. Risk factors for COBSI caused by an MDR organism and predictors for 30-day mortality were also determined. RESULTS: A total of 1721 positive blood culture isolates were identified during the study period with a yearly incidence of 30-43 isolates/10 000 ED presentations. The proportion of MDR Escherichia coli causing COBSI increased from 9%-26% (P < 0.001), whilst methicillin-resistant Staphylococcus aureus remained at high levels (20%-30%). A total of 360 patients were included in a matched case-control (1:1) study, and residents in long-term care facilities (adjusted odds ratio [AOR], 4.9 [95% CI, 2.1-11.6]), home wound care (AOR, 5.5 [95% CI, 1.6-18.7]), underlying immunosuppression (AOR, 3.5 [95% CI, 1.6-7.7]), recent surgery (AOR, 3.5 [95% CI, 1.1-11.6]), and exposure to antibiotics within 3 months (AOR, 5.5 [95% CI, 2.8-10.6]) were independently associated with MDR COBSI. High risk source of COBSI, age and Pitt bacteraemia score were independent predictors for 30-day mortality. CONCLUSIONS: A concerning trend in MDR organisms causing bloodstream infection from the community is occurring. Risk factors for MDR organisms have been identified to assist in empiric antibiotic prescribing for those presenting to hospital with sepsis.

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