Friedman et al evaluated bloodstream infections in patients who have had an association with health care facility or provider prior to onset. The isolates from these patients tend to resemble nosocomial pathogens, with an increased risk for antibiotic-resistant organisms. The authors are from Duke University, Durham Regional Hospital and Nash General Hospital in North Carolina.
Criteria for health-care associated blood stream infection:
(1) positive blood culture collected on hospital admission or within 48 hours of admission (or as an outpatient)
(2) blood culture isolate clinically significant (not a contaminant)
(3) one or more associations with health care
Associations with health-care:
(1) home therapy within previous 30 days, including IV therapy, wound care or specialized nursing care
(2) attended a hospital clinic within previous 30 days
(3) attended a hemodialysis clinic within previous 30 days
(4) receiving IV chemotherapy within the previous 30 days
(5) residing in a nursing home or long-term care facility
(6) hospitalized for >= 2 days within the previous 90 days (an infection occurring shortly after discharge would be classified as nosocomially acquired)
A person with a positive blood culture who does not meet criteria for a nosocomial or health-care associated infection is considered to have a community-acquired bloodstream infection.
