Temporal Trends in Blood Stream Infection Isolates from Surgical XXXX .

@entity1 @entity281 @entity204 @entity2259 @entity130
BACKGROUND: Blood stream @entity281 (BSIs) are a common source of morbidity and @entity204 in hospitalized @entity1 . We hypothesized that the proportions of @entity2259 from gram-positive and fungal pathogens have decreased over time, whereas rates of gram-negative @entity2259 have increased as a result of better central venous catheter management. METHODS: All U.S. Centers for Disease Control and Prevention-defined BSIs in @entity1 treated on the general surgery and @entity130 services at our institution between January 1, 1998, and December 31, 2009 were identified prospectively. These cases were analyzed on a yearly basis to compare rates of various @entity281 over time. The Cochran-Armitage test for trend was used to evaluate categorical data, whereas the Jonckheere-Terpstra test for ordered values was used to analyze continuous data. RESULTS: A total of 1,040 @entity1 had 1,441 episodes of BSI caused by 1,632 strains of bacteria or fungi. There was no difference over time in the proportion of BSI among overall @entity281 . Rates of BSI for gram-negative and fungal pathogens increased over time (p=0.03 and<0.0001, respectively), whereas rates of gram-positive BSI decreased (p<0.0001). Positive changes in anaerobic BSI approached statistical significance. CONCLUSION: Although our hypothesis was only partly true, over the last 12 y, our institution clearly has witnessed a shift in the types of organisms causing BSIs. There was a decrease in the rates of BSI caused by gram-positive pathogens with an associated increase in the rates of BSI of @entity281 by fungal and gram-negative pathogens. Interventions to reduce institutional rates of BSI should include targeted therapies based on historical institutional trends.
