Antibiotic resistance of blood cultures in regional and tertiary hospital settings of Tyrol, Austria (2006-2015): Impacts & trends

Autoři: Peter Kreidl aff001;  Thomas Kirchner aff002;  Manfred Fille aff001;  Ingrid Heller aff001;  Cornelia Lass-Flörl aff001;  Dorothea Orth-Höller aff001
Působiště autorů: Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria aff001;  Department of Orthopedics, Hospital St. Vincent, Zams, Austria aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


Blood stream infections rank among the top seven causes of death of the general population. The aim of our study was to better understand the epidemiology of BSI in order to improve diagnostics and patient outcome. We used retrospective aggregated laboratory data of blood samples received from all public hospitals in Tyrol, Austria between 2006 and 2015. Microorganisms were categorized into obligatory, facultative, unusual pathogens and contaminants. The distribution, the cumulative incidence and antimicrobial susceptibility patterns were compared between the tertiary (TH) and regional peripheral hospitals (PH). Among 256,364 blood samples, 76.1% were from the TH The incidence of obligatory pathogens was 1.7 fold, and up to 3 times higher for facultative, unusual pathogens and contaminants in the TH and increased mainly due to an increase of E.coli, which was the most common isolated pathogen (n = 2,869), followed by Staphylococcus aureus (n = 1,439), Enterococcus sp. (n = 953) and Klebsiella sp. (n = 816). The distribution of obligatory pathogens differed between the hospital settings: In the TH Enterococcus sp. accounted for 40.8% and E.coli for 70.4%, respectively, whereas in the PH for 25.4% (p<0.0001) and 57.8%, respectively (p<0.0001) Antibiotic resistance of Gram negative bacteria and Staphylococcus aureus did not change during the observation period. Carbapenem resistance of Klebsiella sp. and vancomycin and linezolid resistance of Enterococcus faecium showed a non-significant increase since 2010 in the TH setting. We concluded that the incidence of BSI in TH was higher compared to PH. We observed higher contamination rates in the TH. We could not interpret the data of coagulase negative staphylococci due to lack of clinical data. We strongly recommend enhancement of training on blood culture sampling to decrease the rate of contamination. Due to differences in pathogen distribution and antimicrobial resistance between different hospital settings we recommend separate treatment guidelines for BSI by hospital setting.

Klíčová slova:

Antibiotic resistance – Antibiotics – Bacterial pathogens – Blood – Enterococcus – Nosocomial infections – Pathogens – Staphylococcus aureus


1. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19(6):501–509. doi: 10.1111/1469-0691.12195 23473333

2. Conway LJ, Liu J, Harris AD, Larson EL. Risk Factors for Bacteremia in Patients With Urinary Catheter-Associated Bacteriuria. Am J Crit Care. 2016;26(1):43–52. doi: 10.4037/ajcc2017220 27965229

3. Kagan E, Salgado CD, Banks AL, Marculescu CE, Cantey JR. Peripherally inserted central catheter-associated bloodstream infection: Risk factors and the role of antibiotic-impregnated catheters for prevention. Am J Infect Control. 2018.

4. ECDC. Surveillance of antimicrobial resistance in Europe, 2016 2017 [cited 2018 13 Mar].

5. Kirn TJ, Weinstein MP. Update on blood cultures: how to obtain, process, report, and interpret. Clin Microbiol Infect. 2013;19(6):513–520. doi: 10.1111/1469-0691.12180 23490046

6. Hughes D, Karlen A. Discovery and preclinical development of new antibiotics. Ups J Med Sci. 2014;119(2):162–169. doi: 10.3109/03009734.2014.896437 24646082

7. Gastmeier P, Schroder C, Behnke M, Meyer E, Geffers C. Dramatic increase in vancomycin-resistant enterococci in Germany. J Antimicrob Chemother. 2014;69(6):1660–1664. doi: 10.1093/jac/dku035 24615816

8. Towns ML, Jarvis WR, Hsueh PR. Guidelines on blood cultures. J Microbiol Immunol Infect. 2010;43(4):347–349. doi: 10.1016/S1684-1182(10)60054-0 20688297

9. EKM. Mikrobiologie—BactLAB [cited 2018 13 Mar].

10. Krankenanstalten AdTLADu. Krankenanstalten in Tirol Statistische Daten 2016 2017 [cited 2018 06 Sep].

11. Belows A HW, Hermann K, Isenberg H, Shadony H. Manual of Clinical Microbiology. 5th ed. Washington DC: American Society for Microbiology; 1991.

12. Susceptibility ECoA. Breakpoint tables for interpretation of MICs and zone diameters 2017 [cited 2017 28 Sep].

13. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: general principles and contemporary practices. Clin Infect Dis. 1998;26(4):973–980. doi: 10.1086/513938 9564485

14. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis. 2009;49(11):1749–1755. doi: 10.1086/647952 19857164

15. El Feghaly RE, Chatterjee J, Dowdy K, Stempak LM, Morgan S, Needham W, et al. A Quality Improvement Initiative: Reducing Blood Culture Contamination in a Children’s Hospital. Pediatrics. 2018;142(4).

16. Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol. 2007;45(11):3546–3548. doi: 10.1128/JCM.01555-07 17881544

17. Rodriguez-Bano J, Lopez-Prieto MD, Portillo MM, Retamar P, Natera C, Nuno E, et al. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect. 2010;16(9):1408–1413. doi: 10.1111/j.1469-0691.2009.03089.x 19845694

18. Buetti N, Atkinson A, Kottanattu L, Bielicki J, Marschall J, Kronenberg A. Patterns and trends of pediatric bloodstream infections: a 7-year surveillance study. Eur J Clin Microbiol Infect Dis. 2017;36(3):537–544. doi: 10.1007/s10096-016-2830-6 27885442

19. Holmbom M, Giske CG, Fredrikson M, Ostholm Balkhed A, Claesson C, Nilsson LE, et al. 14-Year Survey in a Swedish County Reveals a Pronounced Increase in Bloodstream Infections (BSI). Comorbidity—An Independent Risk Factor for Both BSI and Mortality. PLoS One. 2016;11(11):e0166527. doi: 10.1371/journal.pone.0166527 27835663

20. Laupland KB, Church DL. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev. 2014;27(4):647–664. doi: 10.1128/CMR.00002-14 25278570

21. Luzzaro F, Vigano EF, Fossati D, Grossi A, Sala A, Sturla C, et al. Prevalence and drug susceptibility of pathogens causing bloodstream infections in northern Italy: a two-year study in 16 hospitals. Eur J Clin Microbiol Infect Dis. 2002;21(12):849–855. doi: 10.1007/s10096-002-0837-7 12525919

22. van der Mee-Marquet NL, Blanc DS, Gbaguidi-Haore H, Dos Santos Borges S, Viboud Q, Bertrand X, et al. Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly. Front Microbiol. 2015;6:646. doi: 10.3389/fmicb.2015.00646 26175721

23. Martelius T, Jalava J, Karki T, Mottonen T, Ollgren J, Lyytikainen O. Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999–2013: Trends, patient characteristics and mortality. Infect Dis (Lond). 2016;48(3):229–234.

24. Fille M BM, Hausdorfer J, Heller I, Orth D, Risslegger B, Weiss G C. RESISTENZBERICHT 2012, Resistenzverhalten von Bakterien und Pilzen gegenüber Antibiotika und Antimykotika 2012 [cited 2017 10 Apr].

25. EUCAST Definitive Document E.DEF 2.1, August 2000: Determination of antimicrobial susceptibility test breakpoints. Clin Microbiol Infect. 2000;6(10):570–572. doi: 10.1046/j.1469-0691.2000.00178.x 11168058

26. Schnell D, Lecuyer H, Geeraerts T, Dumenil AS, Bille E, Mercier FJ, et al. Preliminary evaluation of a new clinical algorithm to interpret blood cultures growing coagulase-negative staphylococci. Scand J Infect Dis. 2013;45(7):562–566. doi: 10.3109/00365548.2013.765590 23373849

27. Smith TT, Tamma PD, Do TB, Dzintars KE, Zhao Y, Cosgrove SE, et al. Prolonged linezolid use is associated with the development of linezolid-resistant Enterococcus faecium. Diagn Microbiol Infect Dis. 2018;91(2):161–163. doi: 10.1016/j.diagmicrobio.2018.01.027 29496381

28. Scheckler WE, Bobula JA, Beamsley MB, Hadden ST. Bloodstream infections in a community hospital: a 25-year follow-up. Infect Control Hosp Epidemiol. 2003;24(12):936–941. doi: 10.1086/502162 14700409

29. Tarai B, Jain D, Das P, Budhiraja S. Paired blood cultures increase the sensitivity for detecting pathogens in both inpatients and outpatients. Eur J Clin Microbiol Infect Dis. 2018;37(3):435–441. doi: 10.1007/s10096-018-3188-8 29327210

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2019 Číslo 10
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