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Ljungquist O, Blomstergren A, Merkel A, Sunnerhagen T, Holm K, Torisson G. Incidence, aetiology and temporal trend of bloodstream infections in southern Sweden from 2006 to 2019: a population-based study. Euro Surveill 2023; 28:2200519. [PMID: 36892472 PMCID: PMC9999458 DOI: 10.2807/1560-7917.es.2023.28.10.2200519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BackgroundBloodstream infections (BSI) are a public health concern, and infections caused by resistant bacteria further increase the overall BSI burden on healthcare.AimTo provide a population-based estimate of BSI incidence and relate this to the forthcoming demographic ageing western population change.MethodsWe retrieved positive blood cultures taken from patients in the Skåne region, southern Sweden, 2006-2019 from the Clinical Microbiology Department database and estimated incidence rates (IR), stratified by age (0-49, 50-64, 65-79, ≥ 80 years), sex, year, and species and described antimicrobial susceptibility for Enterobacterales.ResultsWe identified 944,375 blood culture sets, and 129,274 (13.7%) were positive. After deduplication and removal of contaminants, 54,498 separate BSI episodes remained. In total, 30,003 BSI episodes (55%) occurred in men. The overall IR of BSI was 307/100,000 person-years, with an average annual increase of 3.0%. Persons ≥ 80 years had the highest IR, 1781/100,000 person-years, as well as the largest increase. Escherichia coli (27%) and Staphylococcus aureus (13%) were the most frequent findings. The proportion of Enterobacterales isolates resistant to fluoroquinolones and third generation cephalosporins increased from 8.4% to 13.6%, and 4.9% to 7.3%, (p for trend < 0.001), with the largest increase in the oldest age group.ConclusionWe report among the highest BSI IRs to date worldwide, with a higher proportion among elderly persons and males, including resistant isolates. Given expected demographic changes, these results indicate a possible substantial future BSI burden, for which preventive measures are needed.
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Affiliation(s)
- Oskar Ljungquist
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Infectious Diseases, Helsingborg hospital, Helsingborg, Sweden
| | - Adam Blomstergren
- Department of Infectious Diseases, Skåne University hospital, Malmö, Sweden.,Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Adam Merkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Lund, Sweden.,Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gustav Torisson
- Department of Infectious Diseases, Skåne University hospital, Malmö, Sweden.,Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Epidemiology, aetiology and clinical characteristics of clostridial bacteraemia: a 6-year population-based observational study of 386 patients. Eur J Clin Microbiol Infect Dis 2022; 41:1305-1314. [PMID: 36136283 PMCID: PMC9556422 DOI: 10.1007/s10096-022-04491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
The objective of this study is to provide a population-based clinical, epidemiological and microbiological overview of clostridial bacteraemia. All cases of bacteraemia in the Skåne Region between 2014 and 2019 with a species currently belonging to the Clostridium genus were identified in the regional clinical microbiology database. Clinical data were retrieved by medical chart-review. A total of 386 unique episodes of clostridial bacteraemia were found resulting in an incidence rate of 4.9/100.000 person-years. The median age was 76 with 56% males. The incidence rate ratio was 34.3 for those aged 80 + vs 0–59. The minimum inhibitory concentrations varied between species but were universally low for metronidazole and carbapenems. Malignancy was the most common co-morbidity, in 47% of patients and most pronounced for C. septicum. Criteria for sepsis and septic shock were met in 69% and 17%, respectively. The 28-day mortality was 26%. High age, absence of fever, high C-reactive protein and high SOFA-score were all significantly associated with mortality. We present the highest incidence rate of clostridial bacteraemia to date. Clostridial bacteraemia is a severe condition with acute onset, affecting elderly with co-morbidities, most pronounced malignancies. Mortality is related to acute manifestations rather than to background factors.
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