Central Line-associated Bloodstream Infections Cases Research Articles

Central-line associated bloodstream infections secondary to strict anaerobes: Time for A definition change?

Background: Central-line–associated bloodstream infections (CLABSIs) arise from bacteria migrating from the skin along the catheter, by direct inoculation, or from pathogens that form biofilms on the interior surface of the catheter. However, given the oxygen-poor environments that obligate anaerobes require, these organisms are unlikely to survive long enough on the skin or on the catheter after direct inoculation to be the true cause of a CLABSI. Although some anaerobic CLABSIs may meet the definition for a mucosal-barrier-injury, laboratory-confirmed, bloodstream infection (MBI-LCBI), some may be not. We sought to determine the proportion of CLABSIs attributed to obligate anaerobic bacteria, and we sought to determine the pathophysiologic source of these infections. Methods: We performed a retrospective analysis of prospectively collected CLABSI data at 54 hospitals (academic and community) in the southeastern United States from January 2015 to December 2020. We performed chart reviews on a convenient sample for which medical records were available. We calculated the proportion of CLABSIs due to obligate anaerobes, and we have described a subset of anaerobic CLABSI cases. Results: We identified 60 anaerobic CLABSIs of 2,430 CLABSIs (2.5%). Of the 60 anaerobic CLABSIs, 7 were polymicrobial with nonanaerobic bacteria. The most common species we identified were Bacteroides, Clostridium, and Lactobacillus (Table 1). The proportion of anaerobic CLABSIs per year varied from 1.2% to 3.7% (Fig. 1). Of 60 anaerobic CLABSIs, 29 (48%) occurred in the only quaternary-care academic medical center in the database. In contrast, an average of 0.6 (SD, 0.6) anaerobic CLABSIs occurred in the 53 community hospitals over the 6-year study period. Of these 29 anaerobic CLABSIs, 23 (79%) were clinically consistent with secondary bloodstream infections (BSIs) due to gastrointestinal or genitourinary source, but they lacked appropriate documentation to meet NHSN criteria for secondary BSI or MBI-LCBI based on case reviews by infection prevention physicians. The other 6 anaerobic CLABSIs did not have a clear clinical etiology and did not meet MBI-LCBI criteria. In addition, 27 (93%) of 29 anaerobic CLABSIs occurred in patients who were either solid-organ transplant recipients, were stem-cell transplant recipients, or were receiving chemotherapy. Lastly, 27 (93%) of 29 anaerobic CLABSIs were treated with antibiotics. Conclusions: Anaerobic CLABSIs are uncommon events, but CLABSI may disproportionately affect large, academic hospitals caring for a high proportion of medically complex patients. Additional criteria could be added to the MBI-LCBI to better classify anaerobic BSI.Funding: NoneDisclosures: None

Parenteral Nutrition Total Energy Dosing and Risk for Central Line–Associated Bloodstream Infection: A Case-Control Study

Background: Central line–associated bloodstream infection (CLABSI) is a complication of central venous access devices used for parenteral nutrition (PN). PN overfeeding is associated with increased adverse effects; however, whether risk for CLABSI is influenced by PN dosing is uncertain. Objective: The purpose of the study was to assess differences in CLABSI risk associated with recommended total energy dosing in hospitalized adult patients receiving PN. Methods: A case-control study was conducted in a single United States Veterans Health Administration health system to assess the potential CLABSI risk factor of weight-based PN kilocalorie dosing. Hospitalized adult patients who developed CLABSI while receiving PN were identified and compared to a control group of patients who did not develop CLABSI. The exposures evaluated were overfeeding, defined as greater than 30 kcal/kg/day, and underfeeding, defined as less than 20 kcal/kg/day. Results: Twenty-nine cases of CLABSI were identified and compared with 274 controls. Odds of CLABSI were significantly higher in patients receiving greater than 30 kcal/kg/day (OR, 3.63; 95% CI, 1.55-8.48; P < .01). No significant difference in odds was found for patients receiving less than 20 kcal/kg/day (OR, .74; 95% CI, 0.21-2.57; P = .63). Conclusion: Increased risk for CLABSI in hospitalized adult patients receiving PN was found to be associated with overfeeding, but not underfeeding. These results may aid clinicians in the management of patients requiring PN and in the generation of hypothesis for future investigations.

Multi-center prospective study on central line-associated bloodstream infections in 79 ICUs of China

BackgroundChina has not yet established a national surveillance network such as NHSN from America, so there is still no large-scale investigations on central line-associated bloodstream infection (CLABSI) incidence. Several retrospective studies in China reported that the incidence of CLABSI varied due to inconsistent diagnostic criteria. We performed a nationwide survey to investigate the utilization rate of central venous catheters (CVCs) and the incidence of CLABSI in ICUs of different areas of China.MethodsThis is a prospective multi-center study. Patients admitted to ICUs with the use of CVCs between January 1, 2014 and December 31, 2018 were enrolled in this study. Hospitals were given the definition of catheter-related bloodstream infection as: a laboratory-confirmed bloodstream infection where CVC was in place on the date of event or the day before. The characteristics of patients, information of catheterization, implementation rates of precautions, and CLABSIs were collected. The statistical analysis was performed by SPSS 25.0 software and website of Open Source Epidemiologic Statistics for Public Health.ResultsA total of 38,212 patients and 466,585 catheter days were involved in surveillance. The average CLABSI incidence in a thousand catheter days was 1.50, the lowest incidence unit was in pediatric ICU (0/1000 catheter days), and the lowest incidence area was in Northeast China (0.77/1000 catheter days), while the highest incidence unit was in cardiac ICU (2.48/1000 catheter days) and the highest incidence area was in Eastern China (1.62/1000 catheter days). The average utilization rate of CVC was 42.85%, the lowest utilization rate was in pediatric ICU (5.85%) and in Central China (38.05%), while the highest utilization rate was in surgical ICU (64.92%) and in Western China (51.57%). Among the 702 CLABSI cases reported, a total of 735 strains of pathogens were cultured. Staphylococcus spp. was the most common organism isolated (27.07%), followed by Enterobacteriaceae (22.31%). The implementation rates of all precautions showed an upward trend during the study period (P ≤ 0.001).ConclusionThe average incidence of CLABSI in ICUs in China is 1.5/1000 catheter days, similar to the rates reported in developed countries but lower than previous reports in China. CLABSI incidence showed regional differences in China. It is necessary to implement targeted surveillance of CLABSI cases by using standardized CLABSI surveillance definitions and methodologies.

Development of a clinical practice guideline for weaning and discontinuing parenteral nutrition in hospitalized children as part of a central line-associated bloodstream infection-focused quality improvement initiative.

Overprescribing of parenteral nutrition (PN) increases costs and risks to patients, including from central line-associated bloodstream infection (CLABSI). With CLABSI reduction in mind, our children's hospital began an iterative quality improvement effort to decrease PN utilization by first ensuring appropriate initiation and then defining and ensuring appropriate discontinuation. Education was launched along with audits to evaluate for appropriate PN indications. Next, a literature review was conducted to guide the development of an algorithm to appropriately wean and discontinue PN. Lastly, all PN discontinuations were audited for agreement with the new guideline. Retrospectively, monthly PN utilization index (orders per patient-day) was plotted on a statistical process control chart to assess change over time. The presence of PN as a risk factor for CLABSI events and the overall hospital CLABSI rate were trended. Mean PN utilization index fell from 0.156 (July 2018 to January 2019) to 0.12 (February 2019 to August 2020) (P < .01). For 18 months, no PN utilization index reached the baseline lower control limit of 0.144, demonstrating special-cause variation and sustained change. PN as a risk factor for hospital CLABSI cases decreased from most prevalent (49% of cases) to fifth most prevalent (29%) as the CLABSI rate trended down. Engaging frontline staff in the development of a clinical practice guideline and increased accountability to reduce potential patient harm led to a significant and sustained reduction in PN utilization, as well as decreased prevalence of PN as a risk factor in hospital CLABSI cases.

Data Analytics for Diagnosis and Prediction of Central Line-Associated Bloodstream Infections in Critical Care Units.

Central line-associated bloodstream infections are among the leading causes of in-hospital deaths in the United States and are a significant factor for increased morbidity, mortality, and healthcare costs. This study integrates several hospital data systems into a case-controlled database to use data analytics for the identification of significant central line-associated bloodstream infection risk factors and develop time-varying patient risk scores for central line-associated bloodstream infections. A case-control study was performed utilizing patient data collected from various sources then gathered and organized into a case-controlled dataset for analysis examining various patient-specific attributes for central line-associated bloodstream infections. Training and testing sets were created, and multivariate logistic regressions were used to identify risk factors for central line-associated bloodstream infection. Furthermore, the Cox proportional hazards model was used to infer the hazard rate and risk score for central line-associated bloodstream infections for each individual patient during hospitalization. Significant attributes for central line-associated bloodstream infection cases were the ICU location (P = .008), time from insertion (P ≤ .001), number of surgeries (P = .003), and number of central line manipulations (P = .003). Real-time data analytics and point of care at the bedside can facilitate precision care for patients with an elevated central line-associated bloodstream infection risk, subsequently changing the way healthcare prevents hospital-acquired infections.

The Trend of Device-Associated Hospital Acquired Infections in an Adult Intensive Care Unit of a Tertiary Care Hospital: A Need to Revamp Preventive Strategies

Background: Device-associated infections (DAIs) like ventilator-associated pneumonia (VAP), central-line-associated blood stream infections (CLABSI), and catheter-related urinary tract Infection (CAUTI) constitute predominant healthcare-associated infections (HAIs) in intensive care units (ICUs). Objectives: The study aims to elucidate their trends in an adult ICU. Methods: Over 21 months, monthly VAP, CLABSI, and CAUTI rate, and device utilization ratios were calculated in an adult ICU of a tertiary care hospital as part of routine surveillance activity. All cases of VAP, CLABSI, and CAUTI during these 21 months were included. In addition, monthly hand hygiene compliance rates were assessed during the latter period of the study by direct observation method. Results: Nosocomial DAI rate was 49.38 DAI/1000 ICU days. CAUTI, CLABSI, and VAP rates were 17.38, 26.85, 21.08 per 1000 device days, and device utilization ratios were 0.99, 0.61, and 0.02, respectively. Conclusion: The institute had high DAI rates in comparison to other studies from the same city. The declining trend of CAUTI rates roughly coincided with surveillance for hand hygiene compliance in ICU. Thus, it establishes baseline data and underscores the need for focused HIC to maximize patient outcomes.

Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle.

Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality. We describe the impact of various quality improvement interventions on the incidence of CLABSI in an 848-bed community teaching hospital from 1 January 2013 to 31 December 2017. To reduce CLABSI rates after implementation of a comprehensive central line insertion and maintenance bundle. A comprehensive bundle of interventions was implemented incorporating the standard US Centers for Disease Control and Prevention bundle with additional measures such as root-cause analysis of all CLABSI cases, use of passive disinfection caps on vascular access ports, standardisation of weekly central venous catheter (CVC) site dressing changes, and use of antithrombotic and antimicrobial-coated CVCs with fewer lumens. A retrospective study evaluated CLABSI rates and time of CLABSI onset after CVC placement in both intensive care unit (ICU) and non-ICU settings. The annual number of CLABSI cases declined 68% (34 to 11 patients) from 2013 to 2017. There was a 30% decline in CVC days from years 2014 to 2017. Over the same period, CLABSI cases per 1000 CVC days decreased from 0.624 to 0.362: a 42% decline. Following the implementation of a comprehensive bundle of interventions for CVC insertion and maintenance, we found a reduction in rates of CLABSI.

#20: Bloodstream Infections in Pediatric Hematology/Oncology Patients: 3 Years’ Experience of a Specialty Pediatrics Hospital in Tuxtla Gutierrez Chiapas. Mexico

Abstract Background Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. During treatment, cancer patients require a central vascular access; however, central venous catheters are an important source of bloodstream infections. Rigorous infection control measures and continuous surveillance are required to curb the frequency of these infections. Objective We aimed to identify the causative microorganisms in patients with central line–associated bloodstream infection (CLABSI) in hematology-oncology pediatric patients. Material and Methods All pediatric hematology-oncology patients with CLABSI of Specialty Pediatrics Hospital between January 2016 and September 2019 were reviewed. We defined CLABSI according to the Centers of Disease Control and Prevention definition. Demographic data and microbiologic isolation were analyzed. Results Seventy-five cases of CLABSI in 432 patients (mean age 9.5 years) were reported. The incidence of CLABSI was 0.9/1000 catheter-days (80,232 total catheter-days). Patients with acute lymphoblastic leukemia had the highest infection density 2.5 /1000 patients-day. Coagulase-negative staphylococci was isolated in 38.5% (30/75) of significant blood culture (CoNS 38.5%); P. aeruginosa in 18.6% (14/75); K. pneumoniae in 10.6% (3/75); E. coli in 6.6% (5/75); and Candida tropicalis in 5.3%(4/75) of cases. Enterobacteriaceae were broad-spectrum betalactamase producers; P. aeruginosa was susceptible to antibiotics betalactamics with antipseudomonal action and Candida spp. was susceptible to azoles. We did not use lock antibiotic therapy and all the catheters were removed once CLABSI was diagnosed. Empiric antibiotic treatment in CLABSI in Specialty Pediatrics Hospital based on these findings includes ceftazidime plus vancomycin. Conclusions CoNS and P. aeruginosa are the predominant pathogens in CLABSI among pediatric hematology-oncology patient. Antibiotic susceptibility profile has no change during the period of time analyzed, so empiric therapy remains appropriate.

Insertion Site Inflammation Is Associated with Central-Line–Associated Bloodstream Infection

Background: Central lines (CL) are widely used in the inpatient setting and central-line–associated bloodstream infection (CLABSI) is a serious complication of CL use. Because CL insertion site inflammation (ISI) may precede the onset of CLABSI, we aimed to define ISI, to determine whether ISI was associated with CLABSI, and to develop an automated surveillance system for ISI. Methods: We extracted electronic medical records (EMRs) of adult patients hospitalized at the University of Iowa Hospitals &amp; Clinics during January 2015–December 2018. Nurses routinely document CL insertion-site characteristics in specifically designed flow sheets in the EMR. An ISI was counted every time ≥1 of the following signs were documented during CL assessments: edema, erythema, induration, tenderness, or drainage. A 1:2 case-control investigation was performed by matching nonmucosal barrier injury (non-MBI) CLABSI patients (cases) to patients without a CLABSI diagnosis (controls). We matched for age (±10 years), sex, date (±30 days), inpatient unit, central-line days, and central-line type (temporary vs permanent). The main exposure of interest was having an ISI on or before CLABSI onset. CLABSIs were determined using CDC NHSN definitions. We then created a metric: ISI days (defined as the number of days with ≥1 ISI documented) and plotted ISI incidence (ISI days per central-line days) to quantify the burden of ISIs and to determine whether ISI and non-MBI CLABSI incidences were collinear. An automated surveillance system for ISI was created using structured query language queries to the EMR data repository and Tableau software. Results: During 2015–2018, we detected 194 CLABSI cases that were matched to 338 controls. CLABSI patients had greater odds of having an ISI (OR, 2.3; 95% CI, 1.3–4.0). Over the study period, ISI incidence decreased from ~80 to ~50 ISI days per 1,000 CL days. Non-MBI CLABSI rates also decreased from ~1.5 to ~1.0 CLABSIs per 1,000 CL days. Conclusions: ISI incidence is associated with non-MBI CLABSI incidence. Because ISI incidence is higher than CLABSI incidence, surveillance for ISI could be a more sensitive indicator for monitoring the impact of CLABSI prevention practices. Automated surveillance for novel process metrics is a promising infection prevention tool.Funding: NoneDisclosures: None

Reducing Central Line Associated Blood Stream Infections in a Major Academic Facility Using a Novel Comprehensive Tool

<h3>Background</h3> Central line-associated blood stream infections (CLABSIs) are a major source of morbidity, mortality, and increase in cost for healthcare facilities. At our facility, a multi-disciplinary team created a comprehensive tool to prevent higher than expected number of CLABSIs. <h3>Methods</h3> This quality improvement project was conducted at a 953 bed- Level 1 Trauma Teaching Facility, in the 105- bed adult intensive care units (ICUs). On August 2017, a novel comprehensive tool to reduce CLABSI was created by a multi-disciplinary team. The tool was implemented in January 2018. A multidisciplinary team (nurses, vascular access team, physicians, infection prevention), collaborated on CLABSI prevention. The first step was performing Apparent Cause Analysis (ACA) for CLABSI cases. The ACA identified the following improvement opportunities: Device indication, insertion bundle completion, device access, dressing best practices, daily audits, necessity for central lines in patients leaving ICUs, prompt removal of emergent lines (femoral), standardized line insertion and dressing kits, Chlorhexidine Gluconate (CHG) daily bathing, timely identification of CLABSI and posting unit specific CLABSI run charts, and patient education. ACA findings were remediated with staff education (flyers, just-in-time), and the Kamishibai CLABSI maintenance Audit Tool (K card). <h3>Results</h3> Statistically significant reduction in the number of CLABSIs was reported in 2019 (P-value 0.003). In 2016 and 2017, the ICUs reported a Standard Infection Ratio (SIR) of 2. In 2018 and 2019 up to September, the ICUs reported a SIR of 1 and 0.9 respectively. The observed CLABSI reduction was >50% with a decrease from 42 in 2016, to 34 in 2017, to22 in 2018 and 13 in 2019. <h3>Conclusions</h3> Utilizing ACA, involving front-line staff and leadership, providing just-in-time education to targeted staff, continuing education, and ensuring the appropriate audit tools (K card) are in place, enhances staff awareness, resulting in a significant reduction in CLABSI rates.

Association between the Biofilm of Double-Lumen Catheter and Blood Culture in Hemodialysis Patients with Suspected Central Line-Associated Bloodstream Infection

Abstract Background One complication of double lumen catheter (DLC) for hemodialysis (HD) is central line associated bloodstream infection (CLABSI). Blood culture examination is still the gold standard for diagnosis. CLABSI is also often associated with biofilm formation. Biofilms can cause recurrent bacteremia and antibiotic resistance thereby increasing mortality and morbidity. Until now in Dr. Soetomo General Hospital, there have been no objective data or research on the relationship between biofilms and blood cultures in patients with systemic infections associated with catheters. Objective: This study aims to analyze the relationship between the biofilms of double lumen catheter and blood cultures in hemodialysis patients with suspected CLABSI. Method: This was an analytic observational study with cross sectional design to determine the relationship of biofilms and blood culture in HD patients with suspected CLABSI at Dr. Soetomo General Hospital in August 2019 - November 2019. Inclusion criteria: patients aged >18 years with routine HD and suspected CLABSI, also were willing to participate in the study with informed consent. Exclusion criteria: other sources of infection. Biofilm examination on DLC using the test tube method was measured with a nephelometer. Biofilm results is positive if ≤ 0.36 MF and negative if > 0.36 MF. Blood was cultured with a 3D BacT/ALERT tool in the Clinical Microbiology Installation Laboratory of Dr. Soetomo General Hospital. Results: Of the 33 subjects, 45.5% were men and 54.5% were women, with an average age of 49.06 ± 1.5 years. The most common cause of CKD is hypertension (54.5%). The median length of HD was 3 months, ranging from 1-8 months. DLC were mostly inserted at subclavia dextra (87.9%) and installed with a mean duration of 77.94 ± 5.22 days. The majority (66.7%) had normal nutritional status. The mean albumin level was 3.28 ± 0.07 g/dL. There was biofilm growth in 16 subjects (48.5%). The evaluation of blood culture revealed 15 positive results (45.5%). The analysis between biofilm density and CLABSI found significant differences between the two groups (p=0.024). From chi-square test, the association of biofilms with blood culture in HD patients with suspected CLABSI obtained a p value of 0.001. Conclusion: Patients with suspected CLABSI and positive bacteria growth in blood cultures had biofilm in DLC. In addition, the density of biofilms in DLC is higher CLABSI cases. Keywords: chronic kidney disease, CKD, Double lumen catheter, Biofilm, Blood culture, Infection, CLABSI

Routine scrubbing reduced central line associated bloodstream infection in NICU

BackgroundThe main aim of this study was to estimate the effectiveness of routine scrubbing by change of the incidence of central line-associated bloodstream infections (CLABSI). MethodsWe surveyed cultures from the NICU environment in December 2017. We found that areas close to infants harbored more bacteria. We implemented routine scrubbing to control sites with the most bacteria starting from January 2018. We retrospectively reviewed and compared the data between the pre (2017) and post (2018) intervention periods. ResultsA total of 916 infants were included; 10 CLABSI episodes were identified, 9 and 1 episodes in the pre- and postintervention periods, respectively. We found that the incidence of CLABSI decreased significantly among all admitted infants (P = .006) and also among very low birth weight infants (P = .085). The number of CLABSI cases per 1,000 central line days decreased from 1.89 in 2017 to 0.23 in 2018 (P = .018). The most common bacterial species found in the cultures established from the NICU environment were identical to the CLABSI-causing coagulase-negative Staphylococcus. ConclusionsRoutine scrubbing significantly reduced CLABSI in the NICU.

Incidence of Central Line-Associated Blood Steam Infection in Pediatric Intensive Care Unit (PICU)

Background: central line-associated blood stream infection (CLABSI) is responsible for almost 60% of the hospital-acquired infections. The rate of CLABSI in developing countries is higher than that in developed countries. Recently; gram negative bacilli are commonly isolated in CLABSI cases. Aim of the work: This was a prospective 6 month study to assess the occurrence of CLABSI at Pediatric Intensive Care Unit (PICU) of Ain-shams University Hospital. Patients and methods: present study was a prospective observational study conducted on 109 patients with a 152 central venous catheter (CVCs) inserted to them, who were admitted to the Pediatric Intensive Care Unit of Ain Shams University Hospital from July to December 2017. They were observed for development of central lineassociated blood stream infection (CLABSI) and also associated risk factors were studied. Results: There was 22 CLABSI cases with a CLABSI score 14.1 per 1000 central line days. In this study, the most common organism detected was Klebsiella that was isolated in 14 cases. This study shows multi-drug resistant pathogens as causative agent of CLABSI in 9 % of cultures. Conclusion: CLABSI is a common and serious complication to CVCs in PICU. Klebsiella, candida albicans are the common pathogens isolated in CLABSI.

Incidence of Central Line-Associated Blood Steam Infection in Pediatric Intensive Care Unit (PICU)

Background: central line-associated blood stream infection (CLABSI) is responsible for almost 60% of the hospital-acquired infections. The rate of CLABSI in developing countries is higher than that in developed countries. Recently; gram negative bacilli are commonly isolated in CLABSI cases. Aim of the work: This was a prospective 6 month study to assess the occurrence of CLABSI at Pediatric Intensive Care Unit (PICU) of Ain-shams University Hospital. Patients and methods: present study was a prospective observational study conducted on 109 patients with a 152 central venous catheter (CVCs) inserted to them, who were admitted to the Pediatric Intensive Care Unit of Ain Shams University Hospital from July to December 2017. They were observed for development of central lineassociated blood stream infection (CLABSI) and also associated risk factors were studied. Results: There was 22 CLABSI cases with a CLABSI score 14.1 per 1000 central line days. In this study, the most common organism detected was Klebsiella that was isolated in 14 cases. This study shows multi-drug resistant pathogens as causative agent of CLABSI in 9 % of cultures. Conclusion: CLABSI is a common and serious complication to CVCs in PICU. Klebsiella, candida albicans are the common pathogens isolated in CLABSI.

Prevalence of central line associated blood stream infection (CRBSI) and catheter colonization in ICU settings of a tertiary care hospital in sub Himalayan region

Background: Catheter-related bloodstream infections (CRBSIs) are one of the major causes of morbidity and mortality in critically ill hospitalized patients mainly in ICU settings. Emergence of multidrug resistant bacteria makes it compulsory to know the current sensitivity profile of the organism against antimicrobial agents. Objective: To isolate the etiological agents responsible for CRBSI and to find out the spectrum of antimicrobial sensitivity of isolated organisms. Material and Methods: A total of 180 suspected cases of CRBSI were included in the study in which 44 (24.44%) cases were positive for catheter tip colonization. Further isolation was done using standard laboratory procedures. Result: Out of a total of 180 suspected cases of CRBSI 44 cases were found to be positive for catheter tip colonization after which they were divided into two groups 4 (2.2%) had CRBSI while 40 (22.22%) had local catheter infections. Conclusion: Catheter colonization and duration of catheterization has an important role in development of CRBSI which may lead to septicaemia and multi-organ failure. CRBSI must be suspected in the catheterized patient having sign and symptoms of septicaemia.

Analysis of clinical characteristics of pediatric patients with central line-associated bloodstream infection in pediatric intensive care unit: a single-center retrospective study

Objective To analyze the clinical characteristics and change in the infection rate of pediatric patients with hospital-acquired central line-associated bloodstream infection(CLABSI) in PICU, and identify the deficiencies in management, and learn from the experience of developed countries in preventing and controlling CLABSI. Methods The cases of CLABSI diagnosed in the PICU of Beijing Children′s Hospital from July 2014 to September 2017 were selected, the clinical information of the pediatric patients was collected, and the infection rate, the in-hospital mortality, and other indicators of CLABSI were calculated to clarify the clinical characteristics and infection status to improve the current practice standard. Results A total of 13 cases of CLABSI had femoral vein catheters.Among them, hematological tumors were the most common(4/13). The infection rate increased from 0.4 cases/1 000 catheter days in 2014 to 2.5 cases/1 000 catheter days in 2017, while the catheter utilization rate increased from 24.5% to 26.6%, children infected with Gram-negative bacteria were the most common(7/13)and the in-hospital mortality was 23.1%. Conclusion In recent years, the number of CLABSI cases has increased.The maximum sterile barrier measures should be supplemented to the current practice standards, the warning signs for catheter days should be added, and the necessity of indwelling catheter should be evaluated daily to reduce the rate of infection. Key words: Children; Intensive care unit; Health associated infections; Central line; Bloodstream infection

Central Line-associated Bloodstream Infections in Cancer Patients: An Experience from a Tertiary Care Cancer Centre

AbstractIntroduction: Central venous catheters (CVCs) implanted in patients with malignancies may often be associated with local or central line-associated bloodstream infections (CLABSI), which are a major source of morbidity and rarely mortality, making such patients’ care difficult and complicated. Materials and Methods: This retrospective study is a single-centre’s experience including both paediatric and adult patients with malignancy, who had a CVC inserted and were receiving care at cancer centre of our hospital over a period between January 2017 and June 2018. Results: In the period from January 2017 to June 2018, 73 confirmed cases of CLABSIs among cancer patients were included in this study. The rate of CLABSIs was estimated as 2.1 episodes/1000 CVC days. Out of 73 CLABSI cases, Gram-negative bacilli were the predominant causative agents of CLABSI constituting 72.6% (n = 53/73) of isolated organisms, 21.9% (n = 16/73) of infections were caused by Gram-positive cocci while polymicrobial infections accounted for 5.4% (n = 4/73) of these cases. Conclusion: Over the last 20 years, an epidemiologic shift has occurred among CLABSI in cancer patients. These findings should be considered with the development of interventions that will prevent Gram-negative CLABSI after CVC insertion. To our knowledge, this is the first study reporting data on the incidence of CLABSIs in cancer patients at tertiary care hospital from North Indian hospital.

Maximal sterile barrier precautions independently contribute to decreased central line–associated bloodstream infection in very low birth weight infants: A prospective multicenter observational study

The use of peripherally inserted central catheters (PICCs) in neonates differs among various institutions and countries because there are no random controlled trials or large observational studies regarding maximal sterile barrier (MSB) precautions in neonatal intensive care units. Our objective was to investigate the association of MSB implementation with central line-associated bloodstream infection (CLABSI) in very low birth weight infants. This was a prospective multicenter observational study in Japan of infants with birth weight less than 1501 grams and in whom a PICC was placed for the first time between October 2014 and March 2017. Risk factors for CLABSI, both related and unrelated to MSB, were assessed by the mixed-effects Cox proportional hazards model, with the neonatal center variable as the random effect. In total, 33,713 catheter-days among 2383 infants were included. We observed 70 cases of CLABSI. MSB precautions were implemented in 13.9% of insertions and were associated with a lower CLABSI risk (adjusted hazard ratio, 0.20; 95% confidence interval, 0.05-0.84). We found that MSB implementation during PICC insertion in infants with birth weight less than 1501 grams independently contributed to a decrease in CLABSI risk.

Incidence Of Central Line-associated Bloodstream Infections In Intensive Care Units In A Private Hospital (Cairo, Egypt)

Objective: The study aimed to measure the incidence, risk factors and most frequent causative organisms of central line-associated bloodstream infections (CLA-BSI) in the Medical/Coronary and Surgical Intensive Care Units (ICUs) at a private hospital. Methods: This prospective study included 499 patients and was conducted between April 2014 and September 2014 in the Medical/Coronary ICU and Surgical ICU of a private hospital in Cairo, Egypt. Results: Approximately 44% of all the patients admitted to the ICUs underwent Central Venous Catheter (CVC) insertion. The overall incidence density rate of CLA-BSI was 6 cases per 1000 central line-days. The central line utilization rate was 0.94 per 1000 patient-days. The mortality rate among cases with CLA-BSI was 16.8% (95% CI: 13.6% – 20.4%) during the study period. Risk factors for CLA-BSI were detected by univariate analysis and included associated co-morbidities such as heart failure, APACHE II scores of &gt;15, an ICU stay of 5 days or more, duration of CVC placement, subclavian insertion of CVCs, and mechanical ventilation. Additionally, logistic regression analysis identified a long ICU stay of 5 days or more, mechanical ventilation and the presence of heart failure as the only significant predictors. Gram-negative bacteria, especially Enterobacter (36.8%: 95% CI: 16.3%– 61.6%), Pseudomonas aeruginosa (21.1%: 95% CI: 16.0% - 45.5%) were the predominant organisms detected in CLA-BSI cases. Conclusion: CLA-BSI is an important cause of mortality in ICU patients. The infection rate is considerably higher than that in recent studies from developed counties, but it is still lower than the rates reported in comparable published studies in Egypt. Strict adherence to the standard infection prevention practices for critically ill patients is highly recommended.

The Importance of Patients and Caregivers Education to Prevent Central Line Associated Bloodstream Infections in Children with Malignancies: A Single Center Experience

▪BackgroundLong-term placement of central venous catheters (CVCs) is common in children with malignancies. The optimization of antiseptic protocols, together with proper manipulation by well-trained nursing staff, has lowered the incidence of central line associated bloodstream infections (CLABSI). Furthermore, actual chemotherapeutic protocols aim to avoid extensive inpatient hospitalizations.However, self-management of CVCs is not simple: it requires adequate materials and an appropriate education of patients and caregivers. Therefore, the influence of social factors, such as language barriers, may be stronger than expected, especially in tertiary level institutions that act in multicultural settings.MethodsWe retrospectively analyzed patients who were admitted at our hematology-oncology service and who inserted any type of CVC between November 2012 and May 2018. Only patients with a complete and certified history of the CVC status from our experienced nurses were included.Cultural and linguistic barriers (CLB) were defined as patients and families who did not speak Italian as mother tongue together with presence of important social or cultural issues that impaired proper CVC management. Furthermore, patients were stratified according to the presence of CLB (CLB+ versus CLB-). The diagnosis of CLABSI was made according to Center for Disease Prevention and Control Criteria (Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and non-central line-associated Bloodstream Infection). January 2018). A complete antibiogram was available in all cases of CLABSI.Density of infection, defined as number of events/ 1000 CVC days, was calculated as CLABSIs x 1000 / number of central line days. The following risk factors were considered for CLABSI: presence of CLB, total days of CVC placement, total days with CVC spent as an outpatient (outpatient days), ratio between outpatient and inpatient days (O/I days), number of outpatient accesses, type of CVC, neutropenia, underlying disease, hematopoietic stem cell transplantation (HSCT) and type of HSCT. Chi-squared test was used to assess differences for categorical variables and Yates' correction was considered when appropriate. Pearson and Spearman rank correlation tests were applied.Results and DiscussionThirty-seven patients and 45 CVC were included in this study. We observed 8 cases of CLABSI out of 10209 days of catheterization thus the density of infection was 0.78/1000 catheters days.Four patients had CLB and 3 of them developed CLABSI, accounting for 5 out of 8 CLABSI. A significant correlation was observed between the presence of CLB and CLABSI (chi-squared 7.07, p<0.01). Moreover, no difference was observed in O/I days among groups (CLB+ O/I days: 0.75, CLB- O/I days: 0.74, p>0.05). Neither the total days of CVC placement nor the total number of days spent with a CVC as an outpatient were correlated with a higher incidence of CLABSI (Pearson correlation respectively 0.03 and 0.04, p>0.05). Therefore, the outpatient management of CVC alone did not seem to be a risk factor for CLABSI.Noticeable, 75% of patients who developed a CLABSI had a tunneled CVC implanted but a significant correlation between CVC type and CLABSI was not found. Tunneled CVCs were used in nearly 47% of our population; this could partially explain the higher incidence of infections in patients with this type of CVC. According to literature, the highest incidence was observed among neutropenic patients and who was affected by acute lymphoblastic leukemia, although the difference was not statistically relevant. No others significant correlations were observed.ConclusionEven though the number of patients is relative small and differences in the underlying disease may be a confounding element, we found a significant correlation between cultural and linguistic barriers and incidence of CLABSI. Current treatment protocols for many childhood cancers have significantly reduced morbidity and mortality in this group of patients. Thus, it has become particularly important to minimize the risks of complications, included CLABSI, related to therapy. Reducing cultural and language barriers by implementing cultural mediation seems to be a promising way to pursue this objective. At the same time, we trust the importance of CLB is worth deepening with further studies involving a greater number of patients. DisclosuresNo relevant conflicts of interest to declare.