TABLE 2.
Studies comparing health care-associated (HCA) and community-associated (CA) community-onset BSIs
| First author (reference) | Setting/population | HCA BSI definition | Patient differences (vs CA BSI) | Microbiology (vs CA BSI) | Outcome difference (vs CA BSI) |
|---|---|---|---|---|---|
| Friedman (65) | Adults admitted to three hospitals in North Carolina (143 with CA BSI and 186 with HCA BSI) | Community-onset BSI with any specialized therapy in the home, recent attendance at a hospital, hemodialysis, or chemotherapy clinic, recent hospitalization, or residence in a nursing home | More likely to have cancer and renal failure with HCA BSI, and less likely to have HIV infection | Urinary tract infection more common in CA BSI; Staphylococcus aureus most common in HCA BSI and Escherichia coli and Streptococcus pneumoniae most common in CA BSI; MRSA much more common in HCA BSI | 3- to 6-month mortality higher (29% versus 16%; P = 0.019) for HCA BSI than for CA BSI |
| Lenz (66) | Adult residents of Calgary, Canada (3,088 with CA BSI and 2,492 with HCA BSI) | Minor modification of criteria of Friedman et al. (60, 65) | Older, more comorbid illness with HCA BSI | Different distribution of pathogens and higher rates of resistant organisms, including MRSA; more polymicrobial infections with HCA BSI | Longer length of stay and higher 28-day case fatality rate (18% versus 10%; P < 0.001) with HCA BSI |
| Al-Hasan (67) | Gram-negative BSI in residents of Olmsted County, MN (306 with HCA BSI and 427 with CA BSI) | Per criteria of Friedman et al. (65) | Patients with HCA BSI were older | Different distribution of infection foci and pathogens; higher rates of resistance with HCA BSI | Higher 28-day case fatality rate (15% versus 4%; P < 0.001) with HCA BSI |
| Son (50) | Patients admitted to nine university hospitals in Korea (380 with CA BSI and 206 with HCA BSI) | Per criteria of Friedman et al. (65) | Patients with HCA BSI more likely to be male and to have comorbidities and immune-suppressant therapy | Different distribution of infection foci and pathogens; higher rates of resistance with HCA BSI | Higher 30-day case fatality rate (18% versus 10%; P = 0.007) with HCA BSI |
| Kollef (68) | Adults admitted to seven hospitals in the United States (728 [64%] with HCA BSI and 415 with CA BSI) | Recent hospitalization, immune suppression, hemodialysis, or nursing home residence | Patients with HCA BSI were older and more likely to be male and to have comorbidities and a higher severity of illness | Different distribution of infection pathogens; higher rates of primary BSI and resistance with HCA BSI | Higher hospital case fatality (14% versus 4%; P < 0.001) with HCA BSI |
| Evans (69) | Adults with spinal cord injury admitted to two hospitals in the United States (110 with HCA BSI and 36 with CA BSI) | Per criteria of Friedman et al. (65) | Patients with HCA BSI were older and more likely to have comorbidities | Trend for higher rates of resistance with HCA BSI | No difference in hospital or 30-day mortality rates |
| Valles (70) | Adults admitted to three teaching hospitals in Spain (581 with CA BSI and 281 with HCA BSI) | Per criteria of Friedman et al. (65) | Patients with HCA BSI were older and more likely to have comorbidities | Different distribution of pathogens and higher rates of resistance, including MRSA; more polymicrobial infections with HCA BSI | Higher case fatality rate (28% versus 10%; P < 0.001) with HCA BSI |