OBJECTIVE To compare the clinical and microbiological characteristics of patients with bloodstream infection (BSI) and to summarize the risk factors for death in these patients.

METHODS Clinical data of 528 patients with BSI admitted to Xijing Hospital, the Fourth Military Medical University from Jul. 2018 to Feb. 2023 were collected. The clinical characteristics, pathogens, antibacterial drug therapy and 28-day case-fatality rate of the patients with BSI were analyzed.

RESULTS Among the 528 patients with BSI, there were 139 patients with community-associated infection, 69 patients with health care-associated infection, and 320 patients with hospital-associated infection. The predominant pathogens isolated from patients with community-associated infection and health care-associated infection were Escherichia coli (53.96% and 42.03%, respectively), while Klebsiella pneumoniae was the main pathogen in patients with hospital-associated infection (24.38%), with a wide variety of major pathogens identified. The drug resistance profiles of E. coli and K. pneumoniae isolated from patients with health care-associated infection were similar to those isolated from patients with hospital-associated infection but were significantly low compared to those isolated from patients with community-associated infection. Compared to patients with community-associated infection, those with health care-associated infection and hospital-associated infection had high 28-day case-fatality rates. Thrombocytopenia (HR =1.764, 95%CI: 1.275-2.440, P=0.001), hypoalbuminemia (HR =2.320, 95%CI: 1.595-3.374, P < 0.001), coagulation dysfunction (HR =1.605, 95%CI: 1.141-2.258, P=0.007), procalcitonin >2.0 ng/ml (HR =3.747, 95%CI: 1.339-10.485, P=0.012), Charlson comorbidity index ≥5 (HR =1.578, 95%CI: 1.110-2.244, P=0.011) and central venous catheterization (HR =1.848, 95%CI: 1.322-2.583, P < 0.001) were risk factors for 28-day mortality, while appropriate targeted antibacterial drug therapy (HR =0.399, 95%CI: 0.291-0.546, P < 0.001) was a protective factor.

CONCLUSION Antibacterial drug therapy for patients with health care-associated infection should be guided by their unique pathogens and resistance profiles, and individualized regimens should be developed based on the site and source of infection, regional microbiological characteristics and disease severity to reduce unnecessary use of antibacterial drug.