Abstract:
Background: The characteristics of bloodstream infections in patients admitted to long-term care wards remain unclear. This study examined differences in nosocomial-onset urinary tract-related bloodstream infections (UTRBSIs) and catheter-related bloodstream infections (CRBSIs) between patients admitted to long-term and acute care wards.
Methods: This retrospective cohort study was conducted at a mixed-care hospital with long-term and acute care wards from April 2015 to March 2024. Patient backgrounds, causative pathogens, antibiotic resistance, and treatment patterns were compared between the two groups.
Results: Among the 252 patients, 108 (42.9%) were diagnosed with UTRBSIs and 87 (34.5%) with CRBSIs. In UTRBSIs, the long-term care group had significantly longer hospitalization (721 vs. 16 days, P < 0.001), more frequent use of indwelling urinary catheters (76.7% vs. 28.6%, P < 0.001), and higher isolation rates of extended-spectrum β-lactamase-producing Enterobacterales (41.1% vs. 8.6%, P < 0.001). Piperacillin/tazobactam and meropenem were significantly more frequently used empirically in the long-term care group. In CRBSIs, the isolation rates of main causative pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) (9.5% vs. 6.7%, P = 0.707) and methicillin-resistant coagulase-negative Staphylococcus spp. (40.5% vs. 48.9%, P = 0.519), showed no significant differences between the two groups despite differences in patient backgrounds. Anti-MRSA agents were rarely used empirically in both groups (19.0% vs. 15.6%, P = 0.779).
Conclusions: Patients admitted to long-term care wards may require empirical therapy for UTRBSIs targeting drug-resistant Enterobacterales, while for CRBSIs, empirical use of anti-MRSA agents may be considered, similar to patients admitted to acute care wards.
Reference:Kumagai K, Inose R, Kimura A, Muraki Y. Comparison of urinary tract-related and catheter-related bloodstream infections in long-term and acute care wards: a retrospective cohort study1. J Infect Chemother. 2025 Mar 27:102690. doi: 10.1016/j.jiac.2025.102690. Epub ahead of print. PMID: 40157571.