Table 2 Comparison between CA and HA in patient characteristics, acquisition, incidence, source of infection, aetiology, clinical features, and mortality
Characteristic | Years | ||||||
|---|---|---|---|---|---|---|---|
1991–1995 | 1996–2000 | 2001–2005 | 2006–2010 | 2011–2015 | 2016–2020 | p | |
Community acquired 4430 (65.4) | 270 | 414 | 449 | 720 | 1252 | 1325 | |
Incidence per 100,000 population | 24.9 | 38.9 | 43.2 | 70.2 | 125.4 | 139.0 | < 0.05 |
Male no (%) | 138 (51.1) | 246 (59.4) | 258 (57.5) | 421 (58.5) | 722 (57.7) | 746 (56.3) | 0.311 |
Age, mean ± SD | 59.9 ± 21.6 | 54.1 ± 26.1 | 61.9 ± 21.1 | 65.8 ± 19.6 | 69.2 ± 16.7 | 71.2 ± 15.5 | < 0.05 |
McCabe fatal-rapidly fatal | 90 (33.3) | 176 (42.5) | 206 (45.9) | 313 (43.5) | 619 (49.4) | 787 (59.4) | < 0.001 |
Urinary catheter | 15 (5.6) | 31 (7.5) | 22 (4.9) | 55 (7.6) | 95 (7.6) | 91 (6.9) | 0.389 |
Previous antimicrobial therapy | 35 (13) | 49 (11.8) | 62 (13.8) | 75 (10.4) | 141 (11.3) | 117 (8.8) | 0.039 |
Neutropenia | 11 (4.1) | 34 (8.3) | 32 (7.1) | 42 (5.9) | 52 (4.2) | 49 (3.7) | 0.001 |
Injecting drug abuser | 34 (12.6) | 29 (7) | 20 (4.5) | 17 (2.4) | 7 (0.6) | 15 (1.1) | < 0.001 |
HIV | 27 (10) | 32 (7.7) | 24 (5.3) | 14 (1.9) | 18 (1.4) | 19 (1.4) | < 0.001 |
Diabetes mellitus | 72 (26.7) | 76 (18.4) | 100 (22.3) | 185 (25.7) | 338 (27) | 397 (30) | < 0.001 |
Cancer | 34 (12.6) | 88 (21.3) | 91 (20.3) | 169 (23.5) | 288 (23) | 316 (23.8) | 0.002 |
Inmunossuppressive treatment | 13 (4.8) | 56 (13.5) | 73 (16.3) | 130 (18.1) | 199 (15.9) | 227 (17.1) | < 0.001 |
Source more frequenty | |||||||
Unknown | 27 (10) | 45 (10.9) | 46 (10.2) | 72 (10) | 104 (8.3) | 83 (6.3) | < 0.001 |
Urinary tract | 67 (24.8) | 85 (20.5) | 118 (26.3) | 200 (27.8) | 434 (34.7) | 511 (38.6) | < 0.001 |
Respiratory tract | 42 (15.6) | 80 (19.3) | 88 (19.6) | 121 (16.8) | 142 (11.3) | 156 (11.8) | < 0.001 |
Biliary tract | 28 (10.4) | 29 (7) | 47 (10.5) | 121 (16.8) | 242 (19.3) | 258 (19.5) | < 0.001 |
Endocarditis | 38 (14.1) | 37 (8.9) | 38 (8.5) | 48 (6.7) | 52 (4.2) | 60 (4.5) | < 0.001 |
Aetiology, most frequent | |||||||
Polymicrobial bacteraemia | 11 (4.1) | 28 (7.1) | 45 (10) | 76 (10.6) | 131 (10.5) | 160 (12.1) | 0.001 |
Monomicrobial bacteraemia | 259 (95.9) | 386 (93.2) | 404 (90) | 644 (89.4) | 1121 (89.5) | 1165 (87.9) | 0.001 |
Gram-negative bacteria | 157 (58.1) | 234 (56.5) | 242 (53.9) | 442 (61.4) | 822 (65.7) | 881 (66.5) | < 0.001 |
E. coli | 88 (32.6) | 125 (30.2) | 162 (36.1) | 318 (44.2) | 593 (47.4) | 613 (46.3) | < 0.001 |
Klebsiella spp. | 6 (2.2) | 12 (2.9) | 23 (5.1) | 33 (4.6) | 78 (6.2) | 87 (6.6) | 0.005 |
Proteus spp. | 12 (4.4) | 9 (2.2) | 15 (3.3) | 16 (2.2) | 31 (2.5) | 42 (3.2) | 0.332 |
Gram-positive bacteria | 102 (37.8) | 152 (36.7) | 178 (39.6) | 238 (33.1) | 368 (29.4) | 380 (28.7) | < 0.001 |
S. aureus | 38 (14.1) | 39 (9.4%) | 43 (9.6%) | 53 (7.4%) | 95 (7.6%) | 78 (5.9%) | < 0.001 |
Strep. pneumoniae | 23 (8.5) | 54 (13) | 68 (15.1) | 82 (11.4) | 77 (6.2) | 90 (6.8) | < 0.001 |
Enterococcus spp. | 4 (1.5) | 11 (2.7) | 8 (1.8) | 12 (1.7) | 35 (2.8) | 48 (3.6) | 0.066 |
Severe sepsis/septic shock | 56 (20.7) | 80 (19.3) | 92 (20.5) | 148 (20.6) | 285 (22.8) | 239 (18) | 0.101 |
Appropriate EAT | 200 (75.5) | 315 (78.6) | 349 (78.4) | 547 (76.9) | 1021 (82.3) | 1032 (79.1) | 0.037 |
30-day mortality | 59 (21.9) | 79 (19.1) | 95 (21.2) | 118 (16.4) | 166 (13.3) | 155 (11.7) | < 0.001 |
Hospital acquired 2347 (34.6) | 206 | 262 | 341 | 455 | 453 | 630 | |
Incidence per 1000 inpatients-days | 0.363 | 0.466 | 0.612 | 0.753 | 0.762 | 1.098 | < 0.05 |
Male nº (%) | 126 (61.2) | 158 (60.3) | 204 (59.8) | 306 (67.3) | 288 (63.6) | 430 (68.3) | 0.028 |
Age, mean ± SD | 64.9 ± 16.1 | 61.7 ± 18.9 | 65.6 ± 15.5 | 65 ± 15.9 | 67.5 ± 14.8 | 69.4 ± 14 | < 0.05 |
McCabe fatal-rapidly fatal | 95 (46.1) | 159 (60.7) | 198 (58.1) | 232 (51) | 269 (59.4) | 422 (67) | < 0.001 |
Urinary catheter | 66 (32) | 56 (21.4) | 89 (26.1) | 168 (35.9) | 191 (42.2) | 205 (32.5) | < 0.001 |
Vascular catheter | 140 (68) | 183 (69.8) | 247 (72.4) | 352 (77.4) | 359 (79.2) | 516 (81.9) | < 0.001 |
Parenteral nutrition | 59 (28.6) | 84 (32.1) | 105 (30.8) | 182 (40) | 193 (42.6) | 271 (43) | < 0.001 |
Mechanical ventilation | 17 (8.3) | 7 (2.7) | 12 (3.5) | 32 (7) | 22 (4.9) | 48 (7.6) | 0.007 |
Previous antimicrobial therapy | 84 (40.8) | 127 (48.5) | 170 (49.9) | 257 (56.5) | 283 (62.5) | 375 (59.5) | < 0.001 |
Neutropenia | 10 (5.2) | 7 (2.7) | 17 (5) | 11 (2.4) | 15 (3.3) | 19 (3) | 0.258 |
Injecting drug user | 4 (1.9) | 8 (3.1) | 3 (0.9) | 6 (1.3) | 1 (0.2) | 3 (0.5) | 0.005 |
HIV | 4 (1.9) | 11 (4.2) | 9 (2.6) | 6 (1.3) | 4 (0.9) | 4 (0.6) | 0.002 |
Diabetes mellitus | 56 (27.2) | 48 (18.3) | 93 (27.3) | 106 (23.3) | 110 (24.3) | 165 (26.2) | 0.112 |
Cancer | 55 (26.7) | 95 (36.3) | 134 (39.3) | 178 (39.2) | 194 (42.8) | 263 (41.7) | 0.002 |
Inmunossuppressive therapy | 29 (14.1) | 43 (16.4) | 81 (23.8) | 109 (24) | 106 (23.4) | 173 (27.5) | < 0.001 |
Surgery | 71 (34.5) | 113 (43.1) | 134 (39.3) | 213 (46.8) | 213 (47) | 232 (36.8) | 0.001 |
Source | |||||||
Unknown | 34 (16.5) | 28 (10.7) | 28 (8.2) | 27 (5.9) | 27 (6) | 27 (4.3) | < 0.001 |
Urinary tract | 30 (14.6) | 29 (11.1) | 60 (17.6) | 70 (15.4) | 77 (17) | 113 (17.9) | 0.166 |
Vascular catheter | 78 (37.9) | 112 (42.7) | 146 (42.8) | 229 (50.3) | 216 (47.7) | 318 (50.5) | 0.006 |
Respiratory tract | 14 (6.8) | 24 (9.2) | 25 (7.3) | 28 (6.2) | 22 (4.8) | 37 (5.9) | 0.304 |
Biliary tract | 9 (4.4) | 21 (8) | 25 (7.3) | 25 (5.5) | 32 (7.1) | 31 (4.9) | 0.285 |
Aetiology, most frequent | |||||||
Polymicrobial bacteraemia | 18 (8.7) | 26 (9.9) | 31 (9.1) | 56 (12.3) | 30 (6.6) | 57 (9.1) | 0.104 |
Monomicrobial bacteraemia | 188 (91.3) | 236 (90.1) | 310 (90.9) | 399 (87.7) | 423 (93.4) | 573 (90.9) | 0.104 |
Gram-negative bacteria | 83 (40.3) | 101 (38.5) | 142 (41.6) | 156 (34.3) | 160 (35.3) | 233 (37) | 0.281 |
E. coli | 35 (17) | 65 (24.8) | 88 (25.8) | 85 (18.7) | 106 (23.4) | 123 (19.5) | 0.028 |
Klebsiella spp. | 8 (3.9) | 10 (3.8) | 14 (4.1) | 17 (3.7) | 16 (3.5) | 28 (4.4) | 0.983 |
Pseud. aeruginosa | 8 (3.9) | 6 (2.3) | 10 (2.9) | 20 (4.4) | 16 (3.5) | 23 (3.7) | 0.755 |
Gram-positive bacteria | 99 (48.1) | 139 (53.1) | 166 (48.7) | 263 (57.8) | 247 (54.5) | 364 (57.5) | 0.023 |
S. aureus | 28 (13.6) | 38 (14.5) | 45 (13.2) | 62 (13.6) | 53 (11.7) | 70 (11.1) | 0.671 |
Coagulase-negative staphylococci | 51 (24.8) | 77 (29.4) | 99 (29) | 167 (36.7) | 162 (35.8) | 237 (37.6) | 0.001 |
Enterococcus spp. | 12 (5.8) | 10 (3.8) | 12 (3.5) | 19 (4.2) | 23 (5.1) | 34 (5.4) | 0.667 |
Severe sepsis/septic shock | 44 (21.4) | 36 (13.7) | 48 (14.1) | 72 (15.8) | 95 (21) | 132 (21) | 0.007 |
Appropriate EAT | 102 (54) | 137 (54.4) | 177 (53) | 246 (55.5) | 255 (58.2) | 366 (60.1) | 0.259 |
30-day mortality | 65 (31.6) | 62 (23.7) | 84 (24.6) | 94 (20.7) | 86 (19) | 116 (18.4) | 0.001 |