Bacteriemias en un hospital de segundo nivel: Estudio epidemiológico, análisis de factores pronósticos asociados a mortalidad y estimación de su coste económico

espanolIntroduccion. Las bacteriemias (B) representan el 0,36% de los ingresos por patologia infecciosa y generan un gasto sanitario importante. El objetivo es analizar una cohorte de pacientes con bacteriemia ingresados en un hospital de segundo nivel: determinar las caracteristicas epidemiologicas y los factores asociados a mortalidad y estimar su coste. Pacientes y Metodos. Estudio observacional retrospectivo de una cohorte de pacientes adultos ingresados con bacteriemia verdadera en un hospital de segundo nivel durante el ano 2010. Se recopilaron los datos clinicos y epidemiologicos de los pacientes y se analizaron los factores asociados a mortalidad. Se estimo el coste economico del ingreso por paciente. Resultados. Se incluyeron 148 episodios: 80 B comunitarias (55,4%), 23 B asociadas a cuidados sanitarios (15,5%) y 45 B nosocomiales (28,5%). La incidencia fue de 9 casos 10.000 habitantes/ano. La edad media fue de 69 anos y la mortalidad global del 24%. En el analisis bivariante se asociaron a mortalidad (p Conclusiones. La gravedad de la enfermedad de base, el tratamiento antibiotico empirico inadecuado y la necesidad de hemodialisis durante el proceso clinico son los principales factores pronosticos de mortalidad en nuestra cohorte de pacientes con bacteriemia. EnglishIntroduction. Bacteraemia (B) accounts for a considerable proportion (0.36%) of all hospital admissions due to infections diseases and it is associated to increased hospital costs. The aim of this study is to describe a cohort of patients with bacteraemia at a second level hospital, to analyze factors associated to mortality and its economical impact during hospital admission. Patients and Methods. Observational study of a cohort of adult patients with bacteraemia admitted at a second level hospital during 2010. Data collection from clinical records has been done according to a standard protocol: epidemiological and clinical variables and factors associated to mortality were analysed. Total economical cost per patient was estimated. Results. 148 patients were included: 80 community B (55.4%), 23 health care associated B (15.5%) and 45 nosocomial B (28.5%). The incidence was 9 cases 10.000 persons/year. Mean age was 69 years and the global mortality was 24%. In bivariate analysis smoking, diabetes mellitus, McCabe Jackson score type I-II, Pitt Index ≥ 3, APACHE ≥ 20, Glasgow ≤9, shock, respiratory distress, invasive procedures, nosocomial bacteraemia and inadequate empiric or definitive antibiotic treatment were associated to mortality (p Conclusions. Comorbidity, inadequate empiric antibiotic treatment and haemodialysis during acute phase are statistically significantly in our cohort of patients with bacteraemia.