Bacteraemia and fungaemia in an Australian general hospital--associations and outcomes.

Abstract

OBJECTIVE: To obtain a comprehensive overview of bacteraemia and fungaemia in a general hospital and thus to determine the incidence, primary sites of sepsis, organisms involved and associated mortality. DESIGN: A prospective laboratory and clinical evaluation of all episodes where microorganisms were cultured from blood over one year. SETTING: The two major hospitals in the Australian Capital Territory which have both community and referral functions. These hospitals provide obstetric and paediatric services along with adult medicine and surgery. PATIENTS: All those who acquired bacteraemia in hospital or presented with a blood-stream infection documented by a positive blood culture. RESULTS: During 1990, 474 clinical episodes of bacteraemia or fungaemia were detected in 446 patients. Significant isolates were identified in 317 of these episodes. The incidence of significant sepsis was 8.1 episodes per 1000 admissions. The most common organisms isolated were Staphylococcus aureus (75 episodes) and Escherichia coli (70 episodes). One hundred and twenty-eight episodes were hospital acquired. Intravenous catheters were the primary sites of sepsis in 68 episodes. Fifty patients died. Higher mortality rates were associated with patients over 60 years of age, respiratory tract sepsis, endocarditis and the presence of an underlying malignancy. CONCLUSION: Bacteraemia and fungaemia are common problems. Nosocomial bacteraemia accounted for 40% of episodes. Half of these nosocomial infections were iatrogenic. Many of the episodes of intravenous catheter sepsis were potentially preventable. Ongoing programs of surveillance of bacteraemia, with the evaluation of primary site, associated features and mortality, are essential to monitor the dimensions of this problem and aid in implementing effective preventive strategies.