Case Fatality Rate Associated with Hospital Acquired Blood Stream Infection among Admitted Patients in a Tertiary Hospital in Oman: A Cross-sectional Study

Background : Evidence from industrialized/developed countries showed high case fatality rate (CFR) estimates associated with hospital-acquired bloodstream infections (HA-BSIs). Surveys have shown that HA-BSIs were responsible for 20%-60% of hospitalization-related deaths. Despite the high morbidity and fatality, to our knowledge, few published reports on HA-BSI prevalence estimates exist in Arab countries, including Oman. Aim: In order to contribute towards reducing mortality associated with HA-BSI, this study was designed to explore three interrelated aims: 1) to describe the socio-demographic and clinical characteristics of deceased and survived HA-BSI cases among admitted patients; 2) to investigate the observed and standardized CFR of HA-BSI among admitted patients, stratified by selected socio-demographic and clinical characteristics; and 3) to estimate the observed pathogen-specific CFR of HA-BSI among admitted patients. Methods: A hospital-based cross-sectional study reviewed reports of hospital admissions over five years of retrospective follow-up at Sultan Qaboos University Hospital (SQUH), a tertiary teaching hospital in Oman. HA-BSI case fatality rate (CFR) estimates were calculated over selected socio-demographic & clinical characteristics such as age, gender, governorate, year of admission, admitting world, and underlying comorbidities. Data analysis was conducted using the SPSS program. Results : Of the 1246 HA-BSI cases included in this study, 350 were deceased, constituting an overall CFR of 28.1%. Deceased cases tend to include more males (59.4%) than females compared to the survived cases (51.1%). Among different age groups, the observed CFR is greatest (31.9%) in the age group (76-85) and lowest (26.6%) in the age group (26-35). The highest standardized CFR was 31.8% in 2015, followed by 30.4 %in 2017. The CFR was significantly highest among patients with HA-BSI admitted to the ICU (52.6%). The highest observed CFR was 62.5% among HA-BSI patients with liver disease, followed by 51.5% in HA-BSI patients with pulmonary disorders. Stenotrophomonas maltophilia, Candida spp, Acinetobacter spp, and Pseudomonas spp were the top four pathogens associated with the highest observed CFR among HA-BSI (43.5%, 41.1%. 40.8% and 40.5%, respectively. Conclusion: The study provides supportive evidence for a varying occurrence in HA-BSI case fatality rate estimates over selected socio-demographic and clinical characteristics. The study calls for the timely adoption of novel HA-BSI surveillance and management systems to reduce mortality associated with HA-BSI.