Table 1.
Clinical Characteristics of 60 Patients with Hospital-Onset Bacteremia and Fungemia (HOB) across 3 Academic Medical Centers (n = 60)
| All Patients | UMMC | JHH | EUH | |||||
|---|---|---|---|---|---|---|---|---|
| No. | (%) | No. | (%) | No. | (%) | No. | % | |
| Total HOB events | 60 | (100) | 20 | (100) | 20 | (100) | 20 | (100) |
| Time from admission to HOB event, median d (IQR) | 16 (7–30) | 18 (7–30) | 24 (9–60) | 11 (8–15) | ||||
| Patient location during blood culture | ||||||||
| Intensive care unit (ICU) | 40 | (67) | 12 | (60) | 20 | (100) | 8 | (40) |
| All adult ICUs | 18 | (30) | 10 | (50) | 0 | (0) | 8 | (40) |
| Neonatal ICU | 2 | (3) | 2 | (10) | 0 | (0) | 0 | (0) |
| Pediatric ICU | 20 | (33) | 0 | (0) | 20 | (100) | 0 | (0) |
| Intermediate acuity unit | 3 | (5) | 3 | (15) | 0 | (0) | 0 | (0) |
| Ward | 17 | (28) | 5 | (25) | 0 | (0) | 12 | (60) |
| Indwelling Devices and Procedures | ||||||||
| Central venous catheter, anyb | 44 | (73) | 9 | (45) | 17 | (85) | 18 | (90) |
| Temporary central line | 14 | (23) | 3 | (15) | 3 | (15) | 8 | (40) |
| Peripherally inserted central catheter | 13 | (22) | 3 | (15) | 4 | (20) | 6 | (30) |
| Port or tunneled catheter | 12 | (20) | 0 | (0) | 8 | (40) | 4 | (20) |
| Dialysis catheter | 8 | (13) | 3 | (15) | 0 | (0) | 5 | (25) |
| Midline | 1 | (2) | 0 | (0) | 0 | (0) | 1 | (5) |
| No central line | 12 | (20) | 7 | (35) | 4 | (20) | 1 | (5) |
| Urinary catheterb | 12 | (20) | 4 | (20) | 1 | (5) | 7 | (35) |
| Mechanical ventilatory supportb | 15 | (25) | 3 | (15) | 6 | (30) | 6 | (30) |
| Other indwelling deviceb,c | 24 | (40) | 7 | (35) | 12 | (60) | 5 | (25) |
| No indwelling deviceb | 6 | (10) | 5 | (25) | 0 | (0) | 1 | (5) |
| Surgery or other invasive procedured prior to HOB | 7 | (12) | 2 | (10) | 3 | (15) | 2 | (10) |
| Microbiology | ||||||||
| Gram positive | 33 | (55) | 10 | (50) | 10 | (50) | 13 | (65) |
| Coagulase-negative Staphylococcus | 17 | (28) | 4 | (20) | 6 | (30) | 7 | (35) |
| Enterococcus spp. | 6 | (10) | 4 | (20) | 1 | (5) | 1 | (5) |
| Methicillin-susceptible S. aureus | 6 | (10) | 2 | (10) | 3 | (15) | 1 | (5) |
| Methicillin-resistant S. aureus | 2 | (3) | 1 | (5) | 0 | (0) | 1 | (5) |
| Streptococci spp. | 3 | (5) | 0 | (0) | 0 | (0) | 3 | (15) |
| Gram negative | 21 | (35) | 7 | (35) | 7 | (35) | 7 | (35) |
| Eschericia coli | 5 | (8) | 2 | (10) | 1 | (5) | 2 | (10) |
| Klebsiella spp. | 4 | (7) | 2 | (10) | 1 | (5) | 1 | (5) |
| Serratia spp. | 4 | (7) | 0 | (0) | 2 | (10) | 2 | (10) |
| Pseudomonas aeruginosa | 3 | (5) | 2 | (10) | 1 | (5) | 0 | (0) |
| Other | 6 | (10) | 2 | (10) | 1 | (5) | 3 | (15) |
| Fungi | 8 | (13) | 2 | (10) | 3 | (15) | 2 | (10) |
| Candida spp | 7 | (12) | 2 | (10) | 2 | (10) | 2 | (10) |
| Other fungi | 1 | (2) | 0 | (0) | 1 | (5) | 0 | (0) |
| Source of bacteremia or fungemia | ||||||||
| Skin contamination | 11 | (18) | 3 | (15) | 4 | (20) | 4 | (20) |
| CLABSI nonmucosal barrier injury | 17 | (28) | 4 | (20) | 6 | (30) | 7 | (35) |
| CLABSI with mucosal barrier injury | 5 | (8) | 0 | (0) | 0 | (0) | 5 | (25) |
| Respiratory tract | 6 | (10) | 2 | (10) | 4 | (20) | 0 | (0) |
| Peripheral IV related | 3 | (5) | 3 | (15) | 0 | (0) | 0 | (0) |
| Pyelonephritis | 3 | (5) | 3 | (15) | 0 | (0) | 0 | (0) |
| CAUTI | 3 | (5) | 1 | (5) | 0 | (0) | 2 | (10) |
| Intra-abdominal abscess or peritonitis | 3 | (5) | 2 | (10) | 1 | (5) | 0 | (0) |
| Ischemic bowel | 2 | (3) | 0 | (0) | 1 | (5) | 1 | (5) |
| Other | 5 | (8) | 2 | (10) | 2 | (10) | 1 | (5) |
| Unknown | 2 | (3) | 0 | (0) | 2 | (10) | 0 | (0) |
| NHSN-reported CLABSI | 12 | (20) | 3 | (15) | 7 | (35) | 2 | (10) |
| Secondary bloodstream infection | 2 | (3) | 0 | (0) | 2 | (10) | 0 | (0) |
Note. EUH, Emory University Hospital; HOB, hospital-onset bacteremia and fungemia; JHH, Johns Hopkins Hospital; NHSN, National Healthcare Safety Network; UMMC, University of Maryland Medical Center; CLABSI, central line-associated bloodstream infection; CAUTI, catheter-associated urinary tract infection; IQR, interquartile range; ICU, intensive care unit.
Pediatric ICU patients in JHH were selected a priori.
Indicates presence within 2 days before or after the date of the blood culture.
Other indwelling devices included arterial line, biliary drain, chest tube, external ventricular drain, extracorporeal membrane oxygenation, fistula drain, gastrostomy tube, intra-aortic balloon pump, intraosseous line, intermittent urinary catheterization, jejunostomy tube, noninvasive high flow respiratory support system, nasogastric tube, surgical drain, ventricular assist device, and ureteral stent.
Invasive procedures included bronchoscopy, cardiac catheterization, feeding tube placement, insertion of a tunneled hemodialysis central line, interventional radiology percutaneous procedure, and transesophageal echocardiogram.