Table 1. Characteristics of Patients by Healthcare Exposure Status.
| Total Cohort (N =578)a | Community-acquired (n=217)a | Healthcare-associated (n=320)a | Hospital-acquired (n=41)a | P valuee | |||
|---|---|---|---|---|---|---|---|
| Patient Characteristics | Age, years, median (range) | 72 (18-97) | 69 (18-97) | 73.5 (19-97) | 73 (36-94) | 0.01 | |
| Male Sex | 257 (44) | 85 (39) | 146 (46) | 26 (63) | 0.01 | ||
| Non-white Race | 266 (47) | 87 (40) | 164 (52) | 15 (34) | 0.02 | ||
| Medicare/Medicaid | 463 (81) | 158 (74) | 267 (85) | 38 (83) | <.001 | ||
| No insurance | 31 (5) | 18 (8) | 12 (4) | 1 (2) | 0.06 | ||
| BMI, median (range) | 25 (13-55) | 27 (13-55) | 24 (13-55) | 24 (18-54) | 0.004 | ||
| Charlson score,bmedian (range) | 3 (0-11) | 1 (0-11) | 3 (0-10) | 3 (0-9) | <.001 | ||
| APACHE II,cmedian (range) | 14 (4-30) | 13 (4-28) | 15 (4-30) | 14 (7-29) | 0.006 | ||
| MCCabe score b | <.001 | ||||||
| Rapidly fatal <2 weeks | 105 (19) | 35 (17) | 56 (18) | 14 (35) | |||
| Ultimately fatal <5 years | 302 (52) | 82 (39) | 199 (62) | 21 (51) | |||
| Nonfatal | 159 (28) | 95 (45) | 59 (18) | 5 (12) | |||
| Dependent in ≥1 ADL b | 323 (56) | 91 (42) | 208 (65) | 24 (59) | <.001 | ||
| Dependent in ≥3 ADL b | 136 (24) | 24 (11) | 107 (34) | 5 (11) | <.001 | ||
| Admission source b | Home | 440 (75) | 211 (100) | 201 (64) | 28 (61) | d | |
| Skilled nursing facility | 121 (21) | 0 (0) | 114 (36) | 7 (15) | |||
| Other hospital | 6 (1) | 0 (0) | 0 (0) | 6 (13) | |||
| Prior hospitalization in last 1 year b | 251 (43) | 0 (0) | 232 (73) | 19 (41) | d | ||
| Comorbidities b | Diabetes | 220 (38) | 70 (32) | 147 (46) | 8 (17) | <.001 | |
| MI | 118 (20) | 40 (18) | 63 (20) | 15 (33) | 0.03 | ||
| CHF | 109 (19) | 29 (13) | 68 (21) | 12 (26) | 0.02 | ||
| PVD | 77 (13) | 26 (12) | 44 (14) | 7 (15) | 0.6 | ||
| Stroke | 112 (19) | 21 (10) | 86 (27) | 5 (5) | <.001 | ||
| Dementia | 102 (18) | 21 (10) | 78 (24) | 3 (7) | <.001 | ||
| COPD | 100 (17) | 31 (14) | 58 (18) | 11 (24) | 0.1 | ||
| Liver disease | 36 (6) | 15 (7) | 17 (5) | 4 (9) | 0.6 | ||
| Dialysis | 35 (6) | 0 (0) | 32 (10) | 3 (7) | d | ||
| Active Malignancy | 127 (22) | 36 (17) | 80 (25) | 11 (24) | 0.05 | ||
| Metastatic Malignancy | 26 (4) | 6 (3) | 16 (5) | 4 (9) | 0.09 | ||
| Decubitus ulcer | 79 (14) | 11 (5) | 62 (19) | 6 (13) | <.001 | ||
| Immunosuppression | 56 (10) | 21 (10) | 31 (10) | 4 (9) | 0.99 | ||
| Devices b | Central IV catheter | 61 (10) | 0 (0) | 47 (15) | 14 (30) | d | |
| Foley catheter | 64 (11) | 0 (0) | 61 (19) | 3 (7) | d | ||
| PEG | 28 (5) | 0 (0) | 23 (7) | 5 (11) | d | ||
| Infection Characteristics | Polymicrobial | 48 (8) | 10 (5) | 30 (9) | 8 (17) | 0.004 | |
| Multiple GN pathogens | 18 (3) | 4 (2) | 10 (3) | 4 (9) | 0.1 | ||
| Multidrug Resistance | 84 (15) | 20 (9) | 58 (18) | 6 (13) | 0.02 | ||
| Primary Source | 0.008 | ||||||
| Urine | 96 (17) | 42 (19) | 48 (15) | 6 (15) | |||
| Wound | 4 (1) | 2 (1) | 2 (1) | 0 (0) | |||
| Lower respiratory tract | 8 (1) | 2 (1) | 3 (1) | 3 (7) | |||
| Other | 9 (2) | 3 (1) | 2 (1) | 4 (10) | |||
| No culture or unknown | 406 (70) | 168 (77) | 223 (70) | 15 (37) | |||
| IV catheter related | 55 (10) | 0 (0) | 42 (13) | 13 (32) | <.001 | ||
| Outcomes |
|
26.9 | 25.9 | 27.9 | 27.3 | 0.02 | |
| (26.2, 28.3) | (25.4, 27.7) | (26.6, 28.9) | (25.3, 48.0) | ||||
|
26.4 | 25.8 | 27.2 | 26.4 | 0.3 | ||
| (25.8, 27.5) | (25.2, 26.8) | (26.1 28.2) | (25.0, 36.8) | ||||
| Disposition | Death or hospice | 82 (14) | 17 (8) | 53 (17) | 12 (29) | <.001 | |
| Discharge to skilled nursing facility | 193 (34) | 18 (8) | 102 (32) | 9 (22) | <.001 | ||
| Discharge home with home health services | 42 (7) | 10 (5) | 28 (9) | 4 (10) | 0.2 | ||
| ICU admission | 151 (26) | 65 (30) | 70 (22) | 16 (40) | 0.02 | ||
| Intubation | 55 (10) | 19 (9) | 27 (9) | 9 (22) | 0.02 | ||
| Vasopressors | 66 (12) | 26 (12) | 32 (10) | 8 (21) | 0.3 | ||
| Readmission in 90 days | 143 (25) | 42 (20) | 93 (29) | 8 (20) | <.001 | ||
| Length of stay post BSI, days, median (range) | 6 (0-158) | 5 (0-158) | 6 (0-143) | 7 (0-52) | 0.3 |
Note: Data are number (%) of bloodstream infection events unless otherwise indicated.
BMI = body mass index; APACHE II = Acute Physiology and Chronic Health Evaluation II score; ADL = activity of daily living; MI = myocardial infarction; CHF = congestive heart failure; PVD = peripheral vascular disease; COPD = chronic obstructive pulmonary disease; IV = intravenous; PEG = percutaneous endoscopic gastrostomy; GN = gram negative; CI = confidence interval; ICU = intensive care unit; BSI = bloodstream infection.
Sums may not equal total N due to small numbers of missing data (not shown) which were less than 10% for any single variable and distributed evenly among groups of healthcare exposure.
Measured on admission.
Measured on day of bloodstream infection.
Significance testing not performed on variables directly used in definitions of healthcare exposure groups.
P values indicate chi-squared or Fisher exact tests for categorical variables, or ANOVA or Kruskall-Wallis tests for continuous variables, as appropriate. All tests were two-sided, using two degrees of freedom. Time to appropriate therapy and time to first therapy were assessed using log-rank tests.