P006: Highlights in bloodstream infections: where does the patient acquire the infection?

Abstract

Introduction: Bloodstream infections (BSI) still account for significant morbidity and mortality. Objectives: The objective of this study was to describe the epidemiology, etiology, sources and adequacy of empiric antimicrobial treatment in BSI. Methods: A retrospective study about all BSI diagnosed during one year. The pattern resistant pathogen study was EPINE-EPPS project. Results: 340 patients were included. Median age was 74.5 years [interquartile range (IQR), 58.5-80.5]; acute physiology and chronic health evaluation (APACHE II) score was 13 (IQR, 7-29). BSI were community-acquired in 56% of the cases. The most common source of BSI was urinary tract (48.3%), intra-abdominal (25.6%) and lower respiratory tract infections (18.6%). The most commonly isolated microorganisms were: Escherichia coli, K. pneumoniae, S. aureus (15% oxacilin resistant) and S. pneumoniae. The 8.6% of enterobacteracea family produced extended-spectrum B-lactamasas (ESBLs). Inappropriate treatment was observed in 24.5% and crude mortality rate was 7.7%. 28% BSI were nosocomial-acquired. The sources of BSI were unknown in 31.7% of the cases and catheter-related in 25.7%. The secondary sources of BSI were intra-abdominal in 57% of the cases. The most common isolated microorganisms were: S. epidermidis and other coagulasa negative, Candida, S. aureus (36% oxacilin resistant) and E. coli. 25% of enterobacteracea family were ESBLs. We found 5 BSI caused by Acitetobacter carbapenem (CPM) resistant and 2 BSI by P. aeruginosa CPM resistant. Inappropriate treatment was observed in 52.5% and mortality rate was 28.7%. Health-care related BSI produced 15.1% of the cases. The source of BSI were unknown in 22.6% and catheter-related in 11.3%. The secondary sources of BSI were urinary tract (60%), intra-abdominal (31.4%) and respiratory tract infections (8.6%). The most common microorganisms were: E. coli, S. aureus (25% oxacilin resistant), S. epidermidis and K. pneumoniae. Inappropriate treatment was noticed in 34% and mortality rate was 17%. Conclusion: The knowledge of local epidemiology is a capital information to improve empiric antimicrobial treatment and to reduce mortalityrelated inappropriate treatment.