Epidemic Outbreak of Catheter-Associated Bloodstream Infections among Patients Receiving Renal Replacement Therapy

Abstract

Background : Hemodialysis is the most common method of renal replacement therapy (RRT), however, its use is associated with risk of catheter-associated bloodstream infections (CABSI). Aims : diagnosis of epidemic trouble on CABSI in multidisciplinary adult hospital associated with the epidemic outbreak of CABSI in patients in RRT, and evaluation of complex of anti-epidemic measures. Materials and methods : in the framework of risk-oriented epidemiological surveillance retrospective and operational epidemiological analysis of morbidity of CABSI and integrated clinical-epidemiological and microbiological examination of cases of outbreak was carried out. The study included patients with central venous catheter (n = 1295), patients receiving renal replacement therapy (n = 235), patients with CABSI (n = 48). 47 S aureus strains were studied, 520 researches were conducted. Results : An outbreak of CABSI of staphylococcal etiology (morbidity 33.01 per 1000 catheterized patients, 95% CI 21.31–44.71), had occurred from September to October 2016, involving 4 departments, manifested as 7 cases of CABSI in patients with RRT and actively identified 4 cases asymptomatic carriers of S. aureus in patients and one staff member of the Office of dialysis (incidence rate – 33.01 per 1000 catheterized patients, 95% CI 44.71–21.31). Sources of infection have served as carriers of S. aureus among patients and staff. Contact pathway of transmission. Place of infection – dialysis department. Cause of the outbreak was the infection of patients in the RRT the hospital S. aureus strain circulating in this hospital with contamination of environmental objects and the formation of a reservoir among personnel and patients. To eliminate the outbreak, a set of measures was carried out, including optimization of monitoring of invasive manipulation of central venous catheterization, elimination of violations of epidemiological safety requirements, disinfection regime change, biological disinfection by bacterial phagocyte, decolonization of S. aureus carriers by bacterial phagocytes. The incidence rate decreased 1.8 times in 2017 compared to 2016, respectively, 12.5 per 1000, 95% CI 10.23–14.77) vs 22.8 per 1000 (95% CI: 22.5–23.1) of catheterized patients. Conclusion : the epidemic outbreak of CABSI in multidisciplinary hospital was identified and eliminated, The outbreak was the result of the circulation in the hospital of S. aureus hospital strain, which formed a reservoir among personnel and patients.