Background: Bloodstream infection present on hospital admission (BSI-POA) is a major cause of morbidity and mortality. The purpose of this study was to measure prevalence and describe the risk factors of patients with BSI-POA and to determine the prevalence of resistance in isolates by admission source.Methods: We conducted a retrospective cohort study of patients discharged from three hospitals in New York City between 2006 and 2014. BSI-POA was defined as BSI diagnosed within 48 h of hospitalisation.Results: The prevalence for BSI-POA was 5307/315,010 discharges (1.7%). The odds of being admitted with BSI-POA were greatest among patients admitted with renal failure, chronic dermatitis, malignancies and prior hospitalisation. Odds ratios and 95% confidence intervals (CI) were 2.72 (95% CI = 2.56–2.88), 2.15 (95% CI = 1.97–2.34), 1.76 (95% CI = 1.64–1.88) and 1.59 (95% CI = 1.50–1.69), respectively. The largest proportion of BSI-POA presented with Staphylococcus aureus(48.4%), followed by Enterococcus faecalis/faecium(20.3%), Klebsiella pneumoniae(16.2%), Streptococcus pneumoniae(8.7%), Pseudomonas aeruginosa(4.2%) and Acinetobacter baumannii(2.2%). Overall, 44% of those admitted from nursing homes presented with antibiotic resistant strains versus 34% from other hospitals and 31% from private homes (P= 0.002).Conclusion: Understanding the risk factors of patients who present to the hospital with BSI could enable timely interventions and better patient outcomes.
