Bloodstream infections: trends and evolution of incidence and etiology in a 12-year period (2010–2021)

Abstract

Introduction

The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic.

Methods

All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated.

Results

No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak.

Conclusions

No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.

Keywords:

• Bloodstream infection
• bacteremia
• incidence
• catheter-related bacteremia
• antimicrobial resistance

Acknowledgements

In memory of Carlos Sánchez Carrillo, without whose dedication and perseverance this work would not have been possible.

Part of this work was presented as a poster (P1195) at the 33rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen (Denmark), April 2023.

Author contributions

The manuscript was written by the authors, with DAM, EB and PM as the overall lead authors. No one who is not listed as an author contributed to writing the manuscript. All authors had full access to all the data in the study and had final responsibility for the decision to submit this report for publication. The authors assume responsibility for the accuracy and fidelity of our data. All authors have read and approved the final version of the manuscript.

Disclosure statement

DAM received support from Angelini and Shionogi to attend meetings. PM reports consulting fees, honoraria for lectures and payment for expert testimony from Gilead, Mundipharma and Pfizer and support for attending meetings from Pfizer. The rest of authors declare no conflicts of interest.

Data availability statement

Requests can be addressed to: David Alonso-Menchén, MD. Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain. E-mail: [email protected].

Additional information

Funding

This study has been funded by Instituto de Salud Carlos III (ISCIII) through the Projects PI20/00575 and PI20/01201 (co-funded by European Regional Development Fund/European Social Fund ‘A way to make Europe’/’Investing in your future’). DAM (CM21/00274) holds a Río Hortega contract funded by the ISCIII. ASM (FI21/00314) holds a FIS predoctoral fellowship funded by the ISCIII.