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Journal article
Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia
JAC-antimicrobial resistance, Vol.7(5), dlaf183
2025
PMID: 41127442
Abstract
Background and objectives
There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data.
Methods
We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models.
Results
The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9–6.5) and 4.1 days (95% CI: 3.8–4.5) for Enterobacterales, 4.9 days (95% CI: 4.5–5.4) and 3.1 days (95% CI: 2.6–3.6) for enterococci, and 6.3 days (95% CI: 5.3–7.3) and 9.8 days (95% CI: 9.1–10.5) for S. aureus.
Conclusions
Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.
Details
- Title
- Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia
- Authors/Creators
- Stephanie J Curtis - Monash UniversitySue J Lee - Monash UniversityBen S Cooper - University of OxfordJan M Bell - Australian Group on Antimicrobial ResistanceGeoffrey W Coombs - Murdoch University, Centre for Biosecurity and One HealthDenise A Daley - Fiona Stanley HospitalAllen C Cheng - The Alfred HospitalDenis W Spelman - Microbiology Unit, Alfred Pathology Service, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, AustraliaAnton Y Peleg - Monash UniversityAndrew J Stewardson - Centre to Impact AMR, Monash University, Clayton, Victoria 3800, Australia
- Publication Details
- JAC-antimicrobial resistance, Vol.7(5), dlaf183
- Publisher
- Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
- Number of pages
- 9
- Identifiers
- 991005823549207891
- Copyright
- © The Author(s) 2025.
- Murdoch Affiliation
- Centre for Biosecurity and One Health; School of Medical, Molecular and Forensic Sciences
- Language
- English
- Resource Type
- Journal article
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