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Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients
Journal article   Open access   Peer reviewed

Seasonal and temperature-associated increases in gram-negative bacterial bloodstream infections among hospitalized patients

Michael R Eber, Michelle Shardell, Marin L Schweizer, Ramanan Laxminarayan and Eli N Perencevich
PloS one, Vol.6(9), e25298
2011
DOI: 10.1371/journal.pone.0025298
PMCID: PMC3180381
PMID: 21966489
url
https://doi.org/10.1371/journal.pone.0025298View
Published (Version of record) Open Access

Abstract

Knowledge of seasonal trends in hospital-associated infection incidence may improve surveillance and help guide the design and evaluation of infection prevention interventions. We estimated seasonal variation in the frequencies of inpatient bloodstream infections (BSIs) caused by common bacterial pathogens and examined associations of monthly BSI frequencies with ambient outdoor temperature, precipitation, and humidity levels. A database containing blood cultures from 132 U.S. hospitals collected between January 1999 and September 2006 was assembled. The database included monthly counts of inpatient blood cultures positive for several clinically important Gram-negative bacteria (Acinetobacter spp, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) and Gram-positive bacteria (Enterococcus spp and Staphylococcus aureus). Monthly mean temperature, total precipitation, and mean relative humidity in the postal ZIP codes of participating hospitals were obtained from national meteorological databases. A total of 211,697 inpatient BSIs were reported during 9,423 hospital-months. Adjusting for long-term trends, BSIs caused by each gram-negative organism examined were more frequent in summer months compared with winter months, with increases ranging from 12.2% for E. coli (95% CI 9.2-15.4) to 51.8% for Acinetobacter (95% CI 41.1-63.2). Summer season was associated with 8.7% fewer Enterococcus BSIs (95% CI 11.0-5.8) and no significant change in S. aureus BSI frequency relative to winter. Independent of season, monthly humidity, monthly precipitation, and long-term trends, each 5.6°C (10°F) rise in mean monthly temperature corresponded to increases in gram-negative bacterial BSI frequencies ranging between 3.5% for E. coli (95% CI 2.1-4.9) to 10.8% for Acinetobacter (95% CI 6.9-14.7). The same rise in mean monthly temperature corresponded to an increase of 2.2% in S. aureus BSI frequency (95% CI 1.3-3.2) but no significant change in Enterococcus BSI frequency. Summer season and higher mean monthly outdoor temperature are associated with substantially increased frequency of BSIs, particularly among clinically important gram-negative bacteria.
Temperature Humans Hospitalization - statistics & numerical data Staphylococcus aureus - pathogenicity Gram-Positive Bacterial Infections - epidemiology Pseudomonas aeruginosa - pathogenicity Klebsiella pneumoniae - pathogenicity Escherichia coli - pathogenicity Enterococcus - pathogenicity Gram-Negative Bacterial Infections - epidemiology Bacteremia - epidemiology Seasons Acinetobacter - pathogenicity

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