Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia

Curtis, SJ; Lee, SJ; Cooper, BS; Bell, JM; Coombs, GW; Daley, DA; Cheng, AC; Spelman, DW; Peleg, AY; Stewardson, AJ

Journal article

Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia

Abstract:: Background and objectives: There are few Australian data regarding the burden of hospital-onset bloodstream infections (HO-BSIs). To quantify the impact of antimicrobial-susceptible and -resistant HO-BSIs on patient outcomes by augmenting laboratory-based surveillance data. Methods: We performed a retrospective cohort study at a tertiary referral hospital in Melbourne, Australia, from 2015 to 2020. We linked administrative data with bloodstream infection surveillance data from the Australian Group on Antimicrobial Resistance. We performed cause-specific Cox proportional hazards regression to quantify the impact of HO-BSI on inpatient mortality and discharge alive, with separate models for Enterobacterales, Staphylococcus aureus, Enterococcus species and the non-fermenting Gram-negative bacilli (NFGNB), Pseudomonas aeruginosa and Acinetobacter species, compared to admissions without HO-BSI. Excess length of stay (LOS) was estimated using multistate models. Results: The cohort of 278 984 admissions included 814 (0.3%) HO-BSIs. Enterobacterales were the most frequent pathogens, followed by enterococci, S. aureus and NFGNB (incidence 3.62, 2.34, 1.11 and 0.80 events per 10 000 patient-days, respectively). Both antimicrobial-resistant and -susceptible HO-BSI increased risk of death and LOS compared with admissions without HO-BSI. Antimicrobial-resistant and -susceptible HO-BSIs, respectively, increased LOS by 5.7 days (95% CI: 4.9–6.5) and 4.1 days (95% CI: 3.8–4.5) for Enterobacterales, 4.9 days (95% CI: 4.5–5.4) and 3.1 days (95% CI: 2.6–3.6) for enterococci, and 6.3 days (95% CI: 5.3–7.3) and 9.8 days (95% CI: 9.1–10.5) for S. aureus. Conclusions: Antimicrobial-susceptible and -resistant HO-BSIs have a substantial impact on patient outcomes. We demonstrated the feasibility of leveraging a national laboratory-based surveillance system to quantify the impact of HO-BSI.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Curtis, S. J., Lee, S. J., Cooper, B. S., Bell, J. M., Coombs, G. W., Daley, D. A., Cheng, A. C., Spelman, D. W., Peleg, A. Y., & Stewardson, A. J. (2025). Mortality and length of stay associated with antimicrobial-susceptible and -resistant hospital-onset bloodstream infections at a tertiary referral hospital in Melbourne, Australia. JAC-Antimicrobial Resistance, 7(5).

MLA Style

Curtis, SJ, et al. “Mortality and Length of Stay Associated with Antimicrobial-Susceptible and -Resistant Hospital-Onset Bloodstream Infections at a Tertiary Referral Hospital in Melbourne, Australia.” JAC-Antimicrobial Resistance, vol. 7, no. 5, 2025.

Chicago Style

Curtis, SJ, SJ Lee, BS Cooper, et al. 2025. “Mortality and Length of Stay Associated with Antimicrobial-Susceptible and -Resistant Hospital-Onset Bloodstream Infections at a Tertiary Referral Hospital in Melbourne, Australia.” JAC-Antimicrobial Resistance 7 (5).
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