Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Baier, Claas; Linke, Lena; Eder, Matthias; Schwab, Frank J.; Chaberny, Iris F.; Vonberg, Ralf‐Peter; Ebadi, Ella

doi:10.1371/journal.pone.0227772

Cited by 77 publications

(87 citation statements)

References 37 publications

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“…However, we also found that the composition ratio of hospital acquired BSIs increased significantly annually (from 73.4-76.2%). This result was consistent with the increase in various hospital-acquired infections in recent years [16,17] , and the risk factors may be related to the risk factors for BSIs and (or) hospital-acquired infections reported in many previous studies, such as ICU admission, the older age of hospitalized patients (aging population), prolonged hospital stay, leukocytopenia, acute myeloid leukemia and (or) increased use of invasive procedures including central venous catheters (CVCs) [18][19][20] . However, more details of the risk factors require further statistical analysis of the decrease in hospital-acquired BSIs in our hospital.…”

Section: Discussionsupporting

confidence: 87%

The incidence rate, species distribution and dynamic trends of bloodstream infection in China, 2010-2019

Cui¹,

Li²,

Wang³

et al. 2020

Preprint

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Background Recent epidemiological studies on bloodstream infections (BSIs) that include the incidence rate, species distribution and dynamic changes are scarce in China. This study was performed to understand these epidemiological data of BSIs over the past 10 years in China. Method Using real-time nosocomial infection surveillance system, this study was retrospectively performed on BSIs in one of the largest hospitals in China, from January 2010 to December 2019. Results From 2010 to 2019, there were totally 9381 episodes of BSIs out of 1,437,927 adult hospitalized patients in the hospital, the total incidence rate of BSIs was 6.50‰ (6.50 episodes per 1000 adult-hospitalized patients per year) and the incidence rates had significantly decreased (8.24‰ to 6.00‰, time trend P <0.05). Among the 9381 episodes of BSIs, 93.1% were bacteremia and others (6.9%) were fungemia. As the most common species, the composition ratios of coagulase-negative staphylococcus (25.6% to 32.5%), Escherichia coli (9.8% to 13.6%) and Klebsiella pneumonia (5.3% to 10.4%) had been dynamic increased (time trends P <0.05) and the proportion of Pseudomonas aeruginosa had dynamic decreased (4.0% to 2.4%, time trend P =0.007). However, Staphylococcus aureus (3.3% to 3.1%) and Acinetobacter baumannii (4.4% to 4.2%) had not changed significantly (time trend P >0.05). These common species were consistent with China Antimicrobial Surveillance Network reported in 2018 (2018 CHINET report), but their composition ratios were different. Additionally, among bacteremia, the proportion of the multidrug-resistant bacteria gradually increased from 52.9% to 68.4% (time trend P <0.001). Conclusion The incidence rate and the species distribution had been dynamic changing and this study could be supplements to the 2018 CHINET report.

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Section: Discussionsupporting

confidence: 87%

The incidence rate, species distribution and dynamic trends of bloodstream infection in China, 2010-2019

Cui¹,

Li²,

Wang³

et al. 2020

Preprint

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“…Unsurprisingly, patients requiring more than one CVC are at higher risk of CRI [ 39 ]. Among cancer patients, patients with hematological malignancies are at higher risk for CRIs compared with patients with solid tumors and the risk of infection is higher in patients with aggressive hematological malignancy such as leukemia and high-grade lymphoma, compared with patients with less aggressive malignancies [ 5 , 40 – 42 ]. Neutropenia is a major independent risk factor for CRIs, and neutropenic patients with bloodstream infections are at higher risk of mortality compared with non-neutropenic patients [ 43 – 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of resulting central line-associated bloodstream infections (CLABSIs) in cancer patients is estimated at 0.5-10 per 1000 CVC-days. The associated mortality ranges from 12 to 40% depending on several factors, including patient comorbidities, CVC type, and microorganism causing the infection [2,[5][6][7][8]. Importantly, up to 70% of all CRIs may be preventable with current evidence-based strategies [9].…”

Section: Introductionmentioning

confidence: 99%

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

et al. 2020

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Cancer patients frequently require central venous catheters for therapy and parenteral nutrition and are at high risk of central venous catheter–related infections (CRIs). Moreover, CRIs prolong hospitalization, cause an excess in resource utilization and treatment cost, often delay anti-cancer treatment, and are associated with a significant increase in mortality in cancer patients. We therefore summoned a panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) and updated our previous guideline on CRIs in cancer patients. After conducting systematic literature searches on PubMed, Medline, and Cochrane databases, video- and meeting-based consensus discussions were held. In the presented guideline, we summarize recommendations on definition, diagnosis, management, and prevention of CRIs in cancer patients including the grading of strength of recommendations and the respective levels of evidence. This guideline supports clinicians and researchers alike in the evidence-based decision-making in the management of CRIs in cancer patients.

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“…Also, a potential relation of insertion site and catheter-related complications has been reported [ 3 , 4 ]. Catheter-related bloodstream infections (CRBSI) are one of the most important infection in those patients, causing up to almost half of all bloodstream infections (BSI), and incidence rates ranging from 10 to 18 per 1000 central venous catheter days [ 5 , 6 ]. Besides the clinical impact, CRBSI are associated with prolonged hospitalizations, significant morbidity and increased health-care costs [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients

et al. 2021

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Background We aimed to describe the epidemiology of catheter-related bloodstream infections (CRBSIs) in onco-hematological neutropenic patients during a 25-year study period, to evaluate the risk factors for Gram-negative bacilli (GNB) CRBSI, as well as rates of inappropriate empirical antibiotic treatments (IEAT) and mortality. Materials/Methods All consecutive episodes of CRBSIs were prospectively collected (1994–2018). Changing epidemiology was evaluated comparing five-year time spans. A multivariate regression model was built to evaluate risk factors for GNB CRBSIs. Results 482 monomicrobial CRBSIs were documented. The proportion of CRBSIs among all BSIs decreased over time from 41.2% to 15.8% (p<0.001). CRBSIs epidemiology has been changing: the rate of GNB increased over time (from 11.9% to 29.4%; p<0.001), as well as the absolute number and rate of multidrug-resistant (MDR) GNB (from 9.5% to 40.0%; p = 0.039). P. aeruginosa increased and comprised up to 40% of all GNB. Independent factors related with GNB-CRBSIs were: longer duration of in-situ catheter (OR 1.007; 95%CI 1.004–1.011), older age (OR 1.016; 95%CI 1.001–1.033), prior antibiotic treatment with penicillins (OR 2.716; 95%CI 1.306–5.403), and current antibiotic treatment with glycopeptides (OR 1.931; 95%CI 1.001–3.306). IEATs were administered to 30.7% of patients, with the highest percentage among MDR P. aeruginosa (76.9%) and S. maltophillia (92.9%). Mortality rate was greater among GNB than GPC-CRBSI (14.4% vs 5.4%; p = 0.002), with mortality increasing over time (from 4.5% to 11.2%; p = 0.003). Conclusion A significant shift towards GNB-CRBSIs was observed. Secondarily, and coinciding with an increasing number of GNB-MDR infections, mortality increased over time.

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Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients

Cited by 77 publications

References 37 publications

The incidence rate, species distribution and dynamic trends of bloodstream infection in China, 2010-2019

The incidence rate, species distribution and dynamic trends of bloodstream infection in China, 2010-2019

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Changing epidemiology of catheter-related bloodstream infections in neutropenic oncohematological patients

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