Study: One-third of patients with BSIs receive inappropriate therapy
New research suggests that as many as one in every three patients with a bloodstream infection is given therapy that is not appropriate. The findings, published in the journal PLOS ONE on March 18, 2014, cite ineffective antibiotics as well as growing drug resistance, and the high prevalence of S. aureus bacteria is among the chief challenges facing community hospitals in their treatment of bloodstream infections, which are a leading cause of death and suffering in the United States.1
In an effort to better understand the types of bloodstream infections that are found in community hospitals, the researchers gathered data on patients seen in community hospitals in Virginia and North Carolina between 2003 and 2006. They then focused in on 1,470 of these patients who had bloodstream infections.
More than half of these infections (56%) were health care-associated, although symptoms began before patients were admitted to the hospital. Another 15% of the infections began while patients were in the hospital. The researchers found that 29% of the infections were acquired in the community and unrelated to medical care.
The most common pathogen responsible for these infections was S. aureus, which was found in 28% of the infections, followed by E. coli, which was found in 24% of the patients. The researchers found that multidrug-resistant pathogens were present in 23% of the patients, representing an increase over previous studies. Of these, methicillin-resistant S. aureus (MRSA) was the most common pathogen involved.
The researchers point out that the findings illustrate that the types of bloodstream infections found in community hospitals are similar to those seen in tertiary care centers, dispelling the misconception that community hospitals don’t commonly see the more serious types of infections. However, the researchers found that 38% of the patients who presented to a community hospital with a bloodstream infection were initially prescribed an antibiotic that was not effective against their infection.
The patients most likely to receive an ineffective antibiotic included patients who were in a hospital or nursing home within the past year and patients with impaired function and/or multidrug-resistant pathogens. Consequently, researchers advise clinicians to consider these risk factors when prescribing antibiotic therapy for bloodstream infections. Further, they note that one way to improve prescribing would be to develop an intervention that prompts electronic medical records to automatically alert providers to these risk factors when they are selecting antibiotic medications.
The researchers note that 250,000 bloodstream infections occur each year, costing an estimated $37,000 per patient. However, most of the research that has been done to date on bloodstream infections has occurred at tertiary care centers rather than community hospitals.
- Anderson DJ, et al. Bloodstream infections in community hospitals in the 21st century: A multicenter cohort study. PLoS One 2014 March 18. [Epub ahead of print]
