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Original Papers
HAI, Bacterial infections
This report was presented in part at ECCMID 2012 in London, UK.
INTRODUCTION
Bloodstream infections (BSIs) are a major cause of morbidity and mortality worldwide [1-8]. These infections may arise secondary to a focus of infection at a specific body site or may be classified as primary when no focus is evident. Although traditionally classified as either hospital-acquired (HA) or community-acquired (CA) infections, it is now widely accepted that a third category of community-onset healthcare-associated (HCA) BSI be recognized [9-11]. In any case, a diagnosis of BSI is a serious condition with associated overall case-fatality rates of about 15-20% [1-8].
Population-based studies have been proposed as the optimal means of defining the epidemiology of infectious diseases. In these designs, all cases of disease occurring in residents of a defined geographical area are ascertained and therefore selection bias is minimized [12]. In addition, when the population at risk is known, incidence rates can be determined that may be used to establish the burden of disease and facilitate comparison between different regions and time periods. However, despite these merits, studies investigating the epidemiology of BSIs have largely been reported from selected hospital-based cohorts [13].
The objective of this report was to investigate the potential value of using population-based designs in evaluating the epidemiology of BSIs. To achieve this goal, population-based BSI data from Calgary, Canada were utilized with illustrative comparisons made with selected subgroup cohorts.
METHODS
Population-based surveillance was conducted in the Calgary Zone of Alberta Health Services using the Electronic Surveillance System (ESS) during 2000-2008 [14]. The Calgary Zone administers all publicly funded healthcare to the 1·24 million population of the cities of Calgary and Airdrie and more than 20 surrounding smaller communities. The population is among the wealthiest, best educated, and youngest in Canada and is rapidly growing due to migration from other parts of the country and abroad. With the exception of acute heart, liver, and lung transplantation which is performed in Edmonton, all healthcare services from primary to tertiary care are provided within the Zone. Since 2000, the ESS has registered all incident episodes of BSIs occurring in residents of the Calgary Zone. Episodes of BSIs are identified by the regional laboratory...