Descriptive study of nosocomial bacteremias at the Johns Hopkins hospital, 1968-1974

Patient, infection and pathogen characteristics are analyzed for 935 cases of nosocomial bacteremia at The John Hopkins Hospital, 1968-1974. The overall nosocomial bacteremia attack rate was 44.1 cases per 1,000 hospital patients. Roughly 6% of all hospital deaths were among patients with nosocomial bacteremias. The case-fatality rate for the seven years was 37.1%, compared with an overall hospital mortality rate of 2.7 deaths per 100 hospital patients. The mortality rate for the entire hospital and the case-fatality rate declined significantly (P < .01) over the seven-year study period. There was a significant increase (P < .01) in Gram-positive nosocomial bacteremias over the seven-year period. During the period, Bacteroides species and Escherichia coli bacteremias increased significantly (P < .01), while Candida species and Klebsiella species bacteremias had significant decreases (P < .01). The nosocomial bacteremia attack rate was high for infants under one year of age, excluding newborns. The attack rates were low for young adults but increased markedly with age in adults older than 40. The cardiac surgery service had the highest nosocomial bacteremia attack rate of 12.4 cases per 1,000 patients. Hospital patients with infective diseases, neoplasms, digestive diseases, diseases of early infancy or circulatory diseases had a much greater risk of acquiring nosocomial bacteremias. Of the 935 cases, 9.5% had multiple episodes of bacteremia.