Background Bloodstream Infections Research Articles

‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England

BackgroundBloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and...

Nutrition therapy cost analysis in the US: pre-mixed multi-chamber bag vs compounded parenteral nutrition.

BackgroundBloodstream infections (BSI) occur in up to 350 000 inpatient admissions each year in the US, with BSI rates among patients receiving parenteral nutrition (PN) varying from 1.3% to 39%. BSI-attributable costs were estimated to approximate $US12000 per episode in 2000. While previous studies have compared the cost of different PN preparation methods, this analysis evaluates both the direct costs of PN and the treatment costs for BSI associated with different PN delivery methods to determine whether compounded or manufactured pre-mixed PN has lower overall costs.ObjectiveThe purpose of this study was to compare costs in the US associated with compounded PN versus pre-mixed multi-chamber bag (MCB) PN based on underlying infection risk.MethodsUsing claims information from the Premier Perspective™ database, multivariate logistic regression was used to estimate the risk of infection. A total of 44 358 hospitalized patients aged ≥18 years who received PN between 1 January 2005 and 31 December 2007 were included in the analyses. A total of 3256 patients received MCB PN and 41 102 received compounded PN. The PN-associated costs and length of stay were analysed using multivariate ordinary least squares regression models constructed to measure the impact of infectious events on total hospital costs after controlling for baseline and clinical patient characteristics.ResultsThere were 7.3 additional hospital days attributable to BSI. After adjustment for baseline variables, the probability of developing a BSI was 30% higher in patients receiving compounded PN than in those receiving MCB PN (16.1% vs 11.3%; odds ratio= 1.56; 95% CI 1.37, 1.79; p<0.0001), demonstrating 2172 potentially avoidable infections. The observed daily mean PN acquisition cost for patients receiving MCB PN was $US164 (including all additives and fees) compared with $US239 for patients receiving compounded PN (all differences p < 0.001). With a mean cost attributable to BSI of $US16 141, the total per-patient savings (including avoided BSI and PN costs) was $US1545.ConclusionIn this analysis of real-world PN use, MCB PN is associated with lower costs than compounded PN with regards to both PN acquisition and potential avoidance of BSI. Our base case indicates that $US1545 per PN patient may be saved; even if as few as 50% of PN patients are candidates for standardized pre-mix formulations, a potential savings of $US773 per patient may be realized.

Blood Stream Infections among febrile patients attending a Teaching Hospital in Western Region of Nepal

Background Blood stream infections (BSIs) are important determinants for prolonged hospital stay and if uncontrolled, progress to become life-threatening. The aim of this study is to determine the common bacterial agents associated with BSI and their antimicrobial susceptibility patterns in a tertiary care teaching hospital in the Western region of Nepal.

The Clinical and Prognostic Importance of Positive Blood Cultures in Adults

Background Bloodstream infections are a major cause of morbidity and mortality in adults. Bloodstream infections should be reassessed periodically because of increased antibiotic resistance, more patients receiving immunomodulatory therapy, improved antiretroviral therapy, and acquisition of infection in health care settings other than hospitals. Methods We conducted retrospective assessment by infectious disease physicians of hospitalized adults with positive blood cultures at 3 academic medical centers. Results Two thousand two hundred seventy positive blood culture episodes occurred in 1706 patients. Of 2669 isolates, 51% represented true infection, 41% contamination, and 8% unknown clinical significance. Although coagulase-negative staphylococci were most common, only 10% were clinically significant. Among 1225 true bloodstream infections, the most frequent isolates were Staphylococcus aureus, Escherichia coli, Enterococcus spp., Klebsiella pneumoniae, coagulase-negative staphylococci, Pseudomonas aeruginosa, Candida albicans, Enterobacter cloacae, and Serratia marcescens. Intravenous catheters were the most common primary source of bloodstream infection (23% of episodes). Most (81%) bloodstream infections were acquired in the hospital or other health care settings. Crude and attributable in-hospital case-fatality ratios were 20% and 12%, respectively, lower than in previous studies. Increasing age, hypotension, absence of fever, hospital acquisition, extreme white blood cell count values, and the presence of the acquired immunodeficiency syndrome, malignancy, or renal disease were significantly associated with an increased risk of in-hospital attributable death in multivariable analysis. Conclusions The proportion of bloodstream infections due to intravenous catheters is continuing to increase. Most episodes were acquired in the hospital or other health care setting. In-hospital case-fatality ratios have decreased compared with previous studies. Several previously identified factors associated with an increased mortality remain statistically significant.

Clinical Performance and Nursing Satisfaction of a Transparent Chlorhexidine Gluconate IV Securement Dressing with Peripherally Inserted Central Catheters

BackgroundBloodstream Infections (BSI) caused by central venous catheters, including peripherally inserted central catheters, can result in longer patient stays and increased complications. Using methods of best practice is needed to reduce the occurrence of these infections. ObjectiveTo evaluate both the clinical performance and nursing satisfaction is using the 3M Tegaderm CHG IV Securement Dressing®. MethodsProspective, controlled, convenience sampling and in a single center, comparing using the 3M Tegaderm CHG IV Securement Dressing® to a regular transparent semi-permeable dressing There were a total of 107 patients in the study sample, and 110 patients in the control sample. ResultsThe results of the satisfaction survey for the investigational dressing group compared with the control dressing group reflected significant p-values of the following primary efficacy variable (1–5 Likert scale), “Overall performance of dressing” (p=0.019951). ConclusionsThe 3M Tegaderm CHG IV Securement Dressing® was easy to apply, able to absorb fluid and mold and conform around the PICC catheters, and rated highly by staff nurses for overall performance of the dressing compared to control dressing.

Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative

BackgroundBloodstream infections are frequent causes of human illness and cause major morbidity and death. In order to best define the epidemiology of these infections and to track changes in occurrence, adverse outcome, and resistance rates over time, population based methodologies are optimal. However, few population-based surveillance systems exist worldwide, and because of differences in methodology inter-regional comparisons are limited. In this report we describe the rationale and propose first practical steps for developing an international collaborative approach to the epidemiologic study and surveillance for bacteremia.FindingsThe founding collaborative participants represent six regions in four countries in three continents with a combined annual surveillance population of more than 8 million residents.ConclusionFuture studies from this collaborative should lead to a better understanding of the epidemiology of bloodstream infections.

Polymicrobial Bloodstream Infections among Children and Adolescents with Central Venous Catheters Evaluated in Ambulatory Care

Bloodstream infections (BSIs) are an ever-present concern for clinicians evaluating ill-appearing pediatric patients with central venous catheters (CVCs) in the ambulatory care setting. We performed a case-control study of a cohort of 200 pediatric patients who were evaluated in the ambulatory care setting and who were found to have laboratory-confirmed BSI in the context of a CVC. This study sought to compare patients with polymicrobial versus monomicrobial BSIs to identify potential risk factors for polymicrobial BSI. Of the 200 patients enrolled in the study, 73 (37%) had a polymicrobial BSI. Patients with polymicrobial BSI were more likely than those with monomicrobial BSI to be younger (P=.002) and less likely to have been recently discharged from the hospital (P=.01). The odds of a polymicrobial BSI were >4 times greater for patients aged <3 years than for those aged >or=3 years (odds ratio, 4.54; 95% confidence interval, 1.68-12.29), and the odds were 50% lower for those discharged from the hospital in the prior 7 days than for those without recent hospitalization (odds ratio, 0.46; 95% confidence interval, 0.22-0.95) after controlling for an underlying cancer diagnosis and the time of year during which a patient presented. Recent antibiotic use, recent BSI, duration that the CVC had been in place, and underlying gastrointestinal dysfunction were not associated with a risk of polymicrobial BSI. Younger children and those who had not recently been discharged from the hospital had an increased risk of developing catheter-related polymicrobial BSI. Special consideration should be given to the increased likelihood of polymicrobial BSIs in these pediatric patients when initiating empirical antimicrobial therapy.

Predictive Value of Leukocytosis and Neutrophilia for Bloodstream Infection

Background Bloodstream infections are an important cause of morbidity and mortality in hospitalized adults. We sought to identify laboratory parameters predictive of blood culture-positivity. Methods We generated a database of patients having positive blood cultures during a 6-month period at our tertiary care community-based medical center. From this patient population, further instances of positive and negative blood culture were identified retrospectively (up to 60 months prior). Differences in laboratory parameters by culture result were studied. Results Of 766 blood cultures, 278 were positive, 395 were negative, and 93 were contaminated. Compared to patients with negative blood cultures, those with positive blood culture had significantly higher WBC count (15,160 ± 460 μl vs. 10,300 ± 200 μl), percent PMN (84.5 ± 0.6% vs. 77.9 ± 0.6%), absolute neutrophil count (12,950 ± 420 μl vs. 8200 ± 200 μl), and bandemia (8.5 ± 1.3% vs. 4.6 ± 0.9%; P = 0.0178). Calculated odds ratios (OR) for positive blood culture included WBC count ≥ = 12,000: OR = 3.16 (95% CI, 2.28–4.37); %PMN ≥ = 80: OR = 4.16 (95% CI, 2.89–5.98), and band PMN ≥ 5%: OR = 3.25 (95% CI, 1.59–6.64). Conclusion Presence of leukocytosis, neutrophilia, and bandemia is highly correlated with blood culture positivity (OR 4.26; 95% CI, 2.48–7.32; RR 49.5). Absence of these findings is inversely associated with blood culture positivity (OR 0.086; 95% CI, 0.044–0.17). A quantitative method of risk assessment is provided based on these parameters to expedite diagnosis and treatment of bloodstream infection.