810 CHEST Original Research CRITICAL CARE Original Research B loodstream infection (BSI) continues to be a severe condition. 1-8 The cause of death in patients with BSI who are admitted to the ICU is often the severity of systemic response, but at same time a delay in appropriate antibiotic administration can lead to progressive deterioration. The correlation between survival and delay in getting appropriate antibiotic treatment has been demonstrated in patients with community-acquired BSI (CAB) who are admitted to the ICU. 3 Infections were traditionally classified as either noso- comial or community acquired. 9,10 However, changes in health-care systems have shifted health-care ser- vices from hospitals to different outpatient facilities. For this reason, a new classification scheme for BSIs has been proposed to distinguish between infections occurring among outpatients having recurrent or recent contact with the health-care system, patients with community-acquired infections, and inpatients with hospital-acquired infections. 11,12 According to this classification, 40% to 50% of patients admitted to the hospital with what are traditionally defined as CABs should be classified as having health-care- associated BSIs (HCABs). 11-13 To our knowledge, no prospective studies have examined the importance of HCABs in patients in the ICU. We aimed to analyze the characteris- tics of HCABs in the ICU and their impact on the Background: Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU. Methods: This work was a multicenter, prospective, observational study of all adult patients with BSI at ICU admission at 27 Spanish hospitals and one Argentine hospital. Cases of BSI were clas- sified as community-acquired BSI (CAB), health-care-associated BSI (HCAB), or hospital-acquired BSI (HAB), and their characteristics were compared. Results: Of 726 BSIs, 343 (47.2%) were CABs, 252 (34.7%) were HABs, and 131 (18.0%) were HCABs. Potentially antibiotic-resistant pathogens were more frequently isolated in HABs (34.8%) and HCABs (27.6%) than in CABs (10.3%) ( P , .001). Logistic regression analysis revealed that HABs (OR, 4.6; 95% CI, 2.9-7.3), HCABs (OR, 3.1; 95% CI, 1.8-5.4), and BSIs of unknown origin (OR, 1.7; 95% CI, 1.0-2.8) were independently associated with the isolation of potentially antibiotic-resistant pathogens. The incidence of inappropriate treatment was significantly higher in HABs (OR, 3.4; 95% CI, 2.1-5.3) and in HCABs (OR, 1.8; 95% CI, 1.0-3.2) than in CABs. Conclusions: One in five BSIs diagnosed at ICU admission is health-care-associated. The inci- dence of potentially drug-resistant pathogens in HCABs is more similar to that of HABs, and they should be treated as such until culture data are available. CHEST 2011; 139(4):810–815 Abbreviations: APACHE 5 Acute Physiology and Chronic Health Evaluation; BSI 5 bloodstream infection; CAB 5 community-acquired bloodstream infection; HAB 5 hospital-acquired bloodstream infection; HCAB 5 health- care-associated bloodstream infection; MRSA 5 methicillin-resistant Staphylococcus aureus; PARP 5 potential antibiotic- resistant pathogen Health-care-Associated Bloodstream Infections at Admission to the ICU Jordi Vallés, MD, PhD; Francisco Alvarez-Lerma, MD; Mercedes Palomar, MD; Armando Blanco, MD; Ana Escoresca, MD; Fernando Armestar, MD; José María Sirvent, MD; Carina Balasini, MD; Rafael Zaragoza, MD; María Marín, MD; and the Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine * Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/22095/ on 06/27/2017