Evolution and aetiological shift of catheter-related bloodstream infection in a whole institution: the microbiology department may act as a watchtower

Abstract

The incidence of central-line-associated bloodstream infection (CLA-BSI) is reported per 1000 days of catheter exposure, mainly in the intensive care unit (ICU), because recording exposure throughout an institution is not always feasible. Confirmation of catheter-related bloodstream infection (CR-BSI) requires specific laboratory testing that identifies the catheter as the source of infection. This information is available in microbiology laboratories and can be assessed using a denominator of 1000 admissions. We evaluated recent trends in the incidence and aetiology of CR-BSI and compared adult ICUs with the remaining areas of the hospital in a retrospective cohort analysis of all confirmed CR-BSIs. During the 8-year study period, we recorded 1208 episodes (8.2% of BSIs) of CR-BSI. After adjusting for the blood cultures drawn, a significant reduction in incidence was observed in adult ICUs (47%), where care bundles had been applied. The reduction was similar irrespective of whether CLA-BSI or CR-BSI was assessed. We recorded a significant reduction in the incidence of Staphylococcus aureus CR-BSI, and a significant increase in the incidence of CR-BSI caused by Enterococcus sp., Gram-negative microorganisms and fungi. The microbiology department may complement CLA-BSI/1000 catheter-days by providing CR-BSI when days of exposure are not available, because both figures are parallel. We demonstrated a significant reduction in the incidence of CR-BSI in recent years in the population admitted to adult ICUs but not in the remaining areas of the hospital. A shift in the aetiological spectrum of CR-BSI may be occurring.

Improving compliance with central venous catheter care bundles using electronic records

“…In our series, we could demonstrate that such lasting effects are possible in a non‐academic centre. We reduced the incidence of CRBSIs within a scope of 12 months from unacceptably high levels to levels in line with the recent international literature (Munoz‐Price et al , ; Bion et al , ; Rodriguez‐Creixems et al , ). The initial infection rates were well above the international average, although in 2006, most of the papers reported CRBSI rates in excess of 5·0/1000 catheter days (Srinivasan et al , ).…”

Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections

“…Incidence of CRBSIs was expressed per 1000 hospital-days [3]. Significance was tested using the chi-square p for trends.…”

“…Another hospital in Barcelona reported a shift towards Gram-negative CRBSIs in their ICU but not in other wards, attributing the change to implementation of a bundled strategy for CRBSI prevention, which preferentially affected Gram-positive CRBSIs [5]. In a large general hospital in Madrid, there was an average annual increase of Gram-negative CRBSIs of 8.9% between 2003 and 2010, whereas the incidence of Gram-positives decreased by 25% [3]. The National Healthcare Safety Network reported on pathogen distribution of central line-associated bloodstream infections in the USA.…”

Micafungin at Physiological Serum Concentrations Shows Antifungal Activity against Candida albicans and Candida parapsilosis Biofilms

“…cause approximately 8 to 15% of bloodstream infections and are the third most common cause of these infections after coagulase-negative staphylococci and Staphylococcus aureus (1)(2)(3)(4)(5)(6)(7)(8).…”