Epidemiology of subsequent bloodstream infections in the ICU

Abstract

Subsequent bloodstream infections (sBSI) occur with a delay after removal of the intravascular catheter (IVC) whose tip revealed microbial growth. Here we describe the epidemiology of sBSI in the intensive care setting. Serratia marcescens, Staphylococcus aureus, Pseudomonas aeruginosa, and yeast were the pathogens most frequently associated with sBSI. In contrast, Enterococci were rarely found in sBSI.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2148-0) contains supplementary material, which is available to authorized users.

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

“…The occurrence of bacteremia caused by common skin organisms (e.g., coagulase-negative staphylococci [CoNS] or Staphylococcus aureus) is a major criterion for the diagnosis of CR-BSI, although gram-negative microorganisms are increasingly observed these past years, 12 especially in case of femoral site of insertion. 13…”

“…141 Considering all microorganisms, the prevalence of subsequent BSI (i.e., delayed BSI with the same microorganism as that recovered from the catheter tip) ranges from 1.3 to 4.1%. [141][142][143][144][145] However, a comparison between studies is difficult because of the lack of a generally accepted definition of subsequent BSI. 144 Therefore, the management of a positive catheter culture without positive blood cultures in a patient without specific symptoms is a challenge at bedside.…”

“…[141][142][143][144][145] However, a comparison between studies is difficult because of the lack of a generally accepted definition of subsequent BSI. 144 Therefore, the management of a positive catheter culture without positive blood cultures in a patient without specific symptoms is a challenge at bedside. The decision of whether antibiotic treatment should be administered depends on the identified microorganism.…”

“…146 Interestingly, treatment within 24 hours after intravascular catheter removal led to a reduction in the incidence of subsequent bacteremia, 146 and therefore, the majority of authors supported the role of antibiotics for S. aureus. [147][148][149][150] An important percentage of subsequent BSI has also been found for P. aeruginosa, 151 extensively resistant Acinetobacter baumannii, 152 Serratia marcescens, 144 and more generally for gramnegative microorganisms. 153 The risk is probably lower for CoNS and Enterococcus spp.…”

“…153 The risk is probably lower for CoNS and Enterococcus spp. 145 Little is known about the significance of a fungal colonization of a catheter tip (i.e., candidemia). While some authors found a low risk of developing subsequent fungemia, 154,155 other studies postulated an increased risk of developing a delayed fungal infection.…”