Association of demographic, clinical and microbiological attributes with preventability among non-commensal hospital-onset bacteraemia and fungaemia (HOB) events (N=1789)
| Number of events with attribute | Potentially preventable HOB events, n (%) | Bivariate (unadjusted) OR (95% CI) | Adjusted OR (95% CI) | ||
| Demographic characteristics | Neonates (0–27 days)* | 62 | 17 (27.4) | 0.68 (0.38 to 1.19) | Reference for age |
| Infants and toddlers (28 days to 23 months) | 87 | 35 (40.2) | 1.23 (0.79 to 1.91) | 2.09 (0.92 to 4.72) | |
| Children (2–11 years) | 74 | 18 (24.3) | 0.57 (0.33 to 0.98) | 1.76 (0.70 to 4.40) | |
| Adolescents (12–17 years) | 62 | 12 (19.3) | 0.42 (0.22 to 0.80) | 1.12 (0.41 to 3.04) | |
| Adult (18 years and older) | 951 | 345 (36.2) | 1.07 (0.88 to 1.30) | 1.88 (0.95 to 3.74) | |
| Older adult (65 years and older) | 553 | 209 (37.8) | 1.15 (0.94 to 1.42) | 2.01 (0.998 to 4.04) | |
| Race—White | 1125 | 390 (34.6) | 0.90 (0.74 to 1.10) | –† | |
| Race—Black | 459 | 183 (39.8) | 1.28 (1.03 to 1.60) | –† | |
| Race—Other | 91 | 21 (23.1) | 0.53 (0.32 to 0.87) | –† | |
| Sex—Male | 1076 | 380 (35.3) | 0.98 (0.80 to 1.19) | –‡ | |
| Organism in index blood culture | Staphylococcus aureus | 407 | 168 (41.3) | 1.37 (1.09 to 1.72) | 1.06 (0.78 to 1.45) |
| Enterococcus faecalis | 156 | 63 (40.4) | 1.25 (0.90 to 1.75) | –‡ | |
| Enterococcus faecium | 123 | 25 (20.3) | 0.44 (0.28 to 0.69) | 0.71 (0.41 to 1.24) | |
| Escherichia coli | 269 | 78 (29.0) | 0.70 (0.53 to 0.94) | 1.18 (0.82 to 1.70) | |
| Klebsiella pneumoniae | 155 | 48 (31.0) | 0.80 (0.56 to 1.14) | –‡ | |
| Pseudomonas aeruginosa | 109 | 42 (38.5) | 1.15 (0.77 to 1.71) | –‡ | |
| Enterobacter cloacae | 83 | 26 (31.3) | 0.82 (0.51 to 1.32) | –‡ | |
| Serratia marcescens | 52 | 29 (55.8) | 2.35 (1.35 to 4.09) | 1.46 (0.75 to 2.85) | |
| Candida sp | 175 | 62 (35.4) | 0.99 (0.72 to 1.38) | –‡ | |
| Polymicrobial | 179 | 49 (27.4) | 0.66 (0.47 to 0.93) | 0.55 (0.36 to 0.83) | |
| Other microbiological characteristics | Positive non-commensal blood culture at least 3 days after admission‡ | 127 | 31 (24.4) | 0.57 (0.37 to 0.86) | –§ |
| Any positive non-commensal blood culture in previous 14 days‡ | 184 | 47 (25.5) | 0.59 (0.42 to 0.84) | 0.36 (0.24 to 0.55) | |
| Matching positive blood culture in previous 14 days‡ | 127 | 30 (23.6) | 0.54 (0.35 to 0.82) | –§ | |
| Index blood culture days 4–7 | 618 | 223 (36.1) | 1.04 (0.85 to 1.27) | –‡ | |
| Index blood culture days 8–14 | 505 | 187 (37.0) | 1.09 (0.88 to 1.35) | –‡ | |
| Index blood culture days 15–21 | 259 | 89 (34.4) | 0.94 (0.71 to 1.24) | –‡ | |
| Index blood culture days 22–28 | 114 | 39 (34.2) | 0.94 (0.63 to 1.40) | –‡ | |
| Index blood culture days greater than 28 | 293 | 98 (33.4) | 0.90 (0.69 to 1.17) | –‡ | |
| Clinical characteristics | Intensive care unit stay 48 hours before index blood culture | 579 | 227 (39.2) | 1.26 (1.03 to 1.55) | 0.93 (0.71 to 1.22) |
| Central line | 1191 | 423 (35.5) | 1.00 (0.81 to 1.22) | –‡ | |
| Mechanical ventilation | 377 | 146 (38.7) | 1.19 (0.94 to 1.50) | –‡ | |
| Urinary catheter | 624 | 240 (38.5) | 1.21 (0.99 to 1.49) | 0.94 (0.72 to 1.22) | |
| Surgery in the past 30 days | 533 | 249 (46.7) | 1.97 (1.60 to 2.42) | 1.56 (1.19 to 2.05) | |
| Procedure in the last 14 days | 720 | 256 (35.6) | 1.00 (0.82 to 1.22) | –‡ | |
| Active malignancy with ongoing chemotherapy | 385 | 63 (16.4) | 0.28 (0.21 to 0.38) | –§ | |
| Receiving immunosuppressive or immunomodulator therapy | 372 | 106 (28.5) | 0.67 (0.52 to 0.86) | –§ | |
| Long-term immunosuppression | 438 | 108 (24.7) | 0.51 (0.40 to 0.65) | 0.63 (0.46 to 0.84) | |
| Dialysis | 324 | 122 (37.7) | 1.12 (0.87 to 1.43) | –‡ | |
| Drug use | 124 | 44 (35.5) | 1.00 (0.68 to 1.46) | –‡ | |
| Current drug use | 84 | 29 (34.5) | 0.95 (0.60 to 1.51) | –‡ | |
| Injection or skin popping | 52 | 17 (32.7) | 0.88 (0.49 to 1.58) | –‡ | |
| Stem cell or bone marrow transplant | 179 | 18 (10.1) | 0.18 (0.11 to 0.30) | –§ | |
| Neutropenia | 339 | 36 (10.6) | 0.17 (0.12 to 0.24) | 0.14 (0.09 to 0.22) | |
| Solid organ transplant | 132 | 50 (37.9) | 1.11 (0.77 to 1.61) | –‡ | |
| Shock | 460 | 155 (33.7) | 0.90 (0.72 to 1.12) | –‡ | |
| Total parenteral nutrition | 296 | 101 (34.1) | 0.93 (0.71 to 1.21) | –‡ | |
| Sources | Gastrointestinal/abdominal source | 622 | 112 (18.0) | 0.27 (0.21 to 0.34) | –§ |
| Neutropenic translocation | 194 | 5 (2.6) | 0.04 (0.02 to 0.10) | –§ | |
| Hepatobiliary source | 90 | 15 (16.7) | 0.35 (0.20 to 0.61) | 0.88 (0.46 to 1.68) | |
| Non-neutropenic, non-hepatobiliary gastrointestinal source | 446 | 108 (24.2) | 0.49 (0.39 to 0.63) | 0.34 (0.25 to 0.48) | |
| Endovascular source | 563 | 299 (53.1) | 2.99 (2.43 to 3.68) | –§ | |
| Intravascular catheter | 488 | 288 (59.0) | 3.94 (3.17 to 4.91) | 5.37 (4.06 to 7.10) | |
| Central line | 435 | 248 (57.0) | 3.30 (2.64 to 4.13) | –§ | |
| Central line—tunnelled and port | 157 | 86 (54.8) | 2.38 (1.71 to 3.32) | –§ | |
| Peripherally inserted central catheter | 155 | 93 (60.0) | 3.01 (2.15 to 4.22) | –§ | |
| Central line—temporary | 132 | 73 (55.3) | 2.40 (1.68 to 3.44) | –§ | |
| Peripheral intravascular | 76 | 53 (72.6) | 4.46 (2.71 to 7.35) | –§ | |
| Respiratory source | 208 | 83 (39.9) | 1.23 (0.92 to 1.66) | –‡ | |
| Ventilator-associated pneumonia | 64 | 29 (45.3) | 1.53 (0.92 to 2.52) | 1.30 (0.73 to 2.32) | |
| Non-ventilator pneumonia | 144 | 54 (37.5) | 1.10 (0.77 to 1.56) | –‡ | |
| Urinary source | 176 | 85 (48.3) | 1.80 (1.32 to 2.47) | –§ | |
| Urinary source with urinary catheter | 64 | 45 (70.3) | 4.54 (2.63 to 7.83) | 5.68 (3.00 to 10.76) | |
| Skin and soft tissue source | 157 | 72 (45.9) | 1.60 (1.15 to 2.23) | 1.19 (0.79 to 1.79) | |
| Surgical site infection source | 102 | 60 (58.8) | 2.75 (1.83 to 4.14) | 4.03 (2.47 to 6.57) | |
| Bone and joint source | 84 | 17 (20.2) | 0.45 (0.26 to 0.77) | 0.40 (0.21 to 0.77) | |
| Central nervous source | 20 | 3 (15.0) | 0.32 (0.09 to 1.09) | 0.36 (0.10 to 1.35) | |
| Reproductive source | 19 | 7 (36.8) | 1.06 (0.42 to 2.70) | –‡ | |
| Other source | 58 | 25 (43.1) | 1.39 (0.82 to 2.36) | –‡ | |
| No source | 312 | 74 (23.7) | 0.51 (0.38 to 0.67) | 0.46 (0.32 to 0.65) | |
| Contaminant | 60 | 40 (66.7) | 3.80 (2.20 to 6.56) | 8.68 (4.52 to 16.69) |
ORs calculated using logistic regression; reference group for each variable is events without that attribute unless otherwise specified; all variables with adjusted ORs reported were included in the multivariable model.
*Each age category was included as a separate variable in bivariate analyses. ‘Neonates’ is the reference category in the multivariable model.
†Race was not adjusted for in multivariable regression.
‡Not included in multivariable model due to χ2 p>0.1 in bivariate analysis.
§Not included in multivariable model due to collinearity with another variable: ‘Active malignancy with ongoing chemotherapy’, ‘Stem cell or bone marrow transplant’ and ‘Neutropenic bowel translocation’ not included due to collinearity with neutropenia; ‘Receiving immunosuppressive or immunomodulator therapy’ not included due to collinearity with ‘Long term immunosuppression’; ‘Positive non-commensal blood culture at least 3 days after admission’ and ‘Matching positive blood culture in previous 14 days’ not included due to collinearity with ‘Any positive non-commensal blood culture in previous 14 days’; ‘Endovascular source’, ‘Central line’, ‘Central line-tunneled and port’, ‘Peripherally inserted central catheter’, ‘Central line-temporary’ and ‘Peripheral Intravascular’ not included due to collinearity with ‘Intravascular catheter’; ‘Urinary source’ not included due to collinearity with ‘Urinary source with urinary catheter’; however, each was significantly associated with HOB preventability in multivariable analysis when included one at a time.