Central Line-associated Bloodstream Infections Incidence Rates Research Articles

Experience of a vascular ultrasound-guided program: from the ICU to the hospital

Abstract Background The use of peripherally inserted central venous catheters (PICCs) has increased worldwide in the last decade. However, PICCs are associated to catheter-related thrombosis (CRT) and central line-associated bloodstream infections (CLABSIs). We describe the characteristics of patients requiring a PICC, estimate the incidence rate, and identify potential risk factors of PICC-related complications. Methods All adult patients requiring a PICC at our institution (Fundación Santa Fe de Bogotá, Bogota, Colombia) from September 2022 to May 2024 were included in the analysis. The database from active PICC monitoring collected demographic and PICC-related information. The incidence rate of CLABSI and CRT, and crude odds ratios (cORs) were estimated. Results Overall, 1936 individuals were included in the study. The median age was 67 years (IQR: 50–78 years), and 51.5% were females. The median duration of PICC lines was 10 days (IQR: 4–17). Seventy-nine patients had catheter-related complications, mostly in the Intensive Care Unit (ICU). The CLABSI and CRT institutional incidence rates per 1000 catheter-days were 2.03 (2.96 in the ICU) and 0.58 (0.61 in the ICU), respectively. Prolonged catheter use (≥ 6 days), PICC insertion in the intensive care unit, and postoperative care after cardiac surgery were identified as potential risk factors for CLABSI, while a catheter insertion into the brachial vein was associated with CRT. Conclusion Daily PICC assessment, particularly in patients with prolonged catheter use, PICC insertion into the brachial vein, or in postoperative care after cardiac surgery may significantly reduce CLABSI and CRT cases. Implementing Vascular Access Teams, venous catheter care bundles, and institutional insertion protocols optimize clinical outcomes.

Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm

BackgroundMost surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU).MethodsWe developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital’s data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period.ResultsFrom January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50–70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06–0.41) and 3.86/1000 catheter days (95% CI: 3.17–4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7–96.9), 100% (95% CI 99.5–100), 100% (95% CI 56.5–100), and 99.9% (95% CI 99.2–100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm.ConclusionsA fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems.

Incidence of central line-associated bloodstream infection in the intensive care unit: A prospective observational study

Aims: The aim of this study was to determine the incidence of central line-associated bloodstream infections (CLABSIs) in the medical and surgical intensive care units (ICUs) of a tertiary care hospital. Materials and Methods: One hundred and twenty patients admitted to medical and surgical ICU with an indwelling, nontunneled central venous catheter (CVC) inserted at admission in the department of emergency medicine or at medical and surgical ICU for more than 48 h were monitored. The patients were followed up daily for the development of new-onset sepsis after 48 h of insertion of CVC, by analyzing the culture of two sets of blood samples, over a span of 24 h. The data were evaluated statistically using Microsoft Excel version 11 and SPSS version 17 (IBM, USA). Results: Among 120 patients hospitalized for an aggregate of 972 days, 7 patients had acquired CLABSI with an incidence rate of 7.2/1000 central line days. The organisms isolated were Staphylococcus aureus, Acinetobacter spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. Conclusion: The incidence rate of CLABSI in this study was in line with other studies on the CLABSI rate in India. The study found a significant association of CLABSI with duration of CVC catheterization, underlying comorbid conditions and diseases of patients, and indication of CVC insertion. However, there was no significant association of CLABSI with age of patients, their gender, and site of insertion.

Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients

BackgroundPeripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution.MethodsThe study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement.ResultsA total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p < 0.001). The CLABSI rate due to multidrug-resistant organisms (MDROs) among the two groups was 3.17 in CVC group and 0.36 in PICC group (p < 0.001). Within CLABSI-CVC group, the most common microorganism detected was MDR Acinetobacter baumannii (27.1%) followed by MDR Klebsiella pneumoniae (22%). In CLABSI-PICC group, the predominant microorganism was Candida spp. (33.3%) followed by non-MDR gram-negative pathogens (22.2%).ConclusionsPICC lines were associated with significantly lower CLABSI rates comparing to CVC although they were in place longer than CVC lines. Given their longer time to the development of infection, PICCs may be a safer alternative for prolonged inpatient IV access. The high prevalence of CLABSI-MDROs depicts the local microbial ecology, emphasizing the need of public health awareness.

Gram-negative central line-associated bloodstream infection incidence peak during the summer: a national seasonality cohort study

Central line-associated bloodstream infections (CLABSI) cause increased morbidity, mortality, and hospital costs that are partially preventable. The phenomenon of seasonality among CLABSI rates has not been fully elucidated, but has implications for accurate surveillance and infection prevention trials. Longitudinal dynamic cohort of hospitals participating in hospital-wide and intensive care unit bloodstream infection surveillance for at least one full year over 2000 to 2014. Mixed-effects negative binomial regression analysis calculated the peak-to-low ratio between months as an adjusted CLABSI incidence rate ratio (IRR) with 95% confidence intervals (CI). Multivariate regression models examined the associations between CLABSI pathogens and ambient temperature and relative humidity. The study population included 104 hospital sites comprising 11,239 CLABSI. Regression analysis identified a hospital-wide increase in total CLABSI during July–August, with a higher gram-negative peak-to-low incidence rate ratio (IRR 2.52 [95% CI 1.92–3.30], p < 0.001) compared to gram-positive bacteria (IRR 1.29 [95% CI 1.11–1.48], p < 0.001). Subgroup analysis replicated this trend for CLABSI diagnosed in the intensive care unit. Only gram-negative CLABSI rates were associated with increased temperature (IRR + 30.3% per 5 °C increase [95% CI 17.3–43.6], p < 0.001) and humidity (IRR + 22.9% per 10% increase [95% CI 7.7–38.3), p < 0.001). The incidence and proportion of gram-negative CLABSI approximately doubled during the summer periods. Ambient temperature and humidity were associated with increases of hospital-acquired gram-negative infections. CLABSI surveillance, preventive intervention trials and epidemiological studies should consider seasonal variation and climatological factors when preparing study designs or interpreting their results.

Indwelling time of peripherally inserted central catheters and incidence of bloodstream infections in haematology patients: a cohort study

BackgroundWe aimed to assess whether longer indwelling time of peripherally inserted central catheters (PICC) increases risk of central line associated bloodstream infections (CLABSI) in haematology patients.MethodsMulticentre retrospective cohort study among haematology patients receiving PICCs between 2013 and 2015. Occurrence of CLABSI based on CDC definitions was assessed. We calculated incidence rates, determined risk factors for CLABSI and used Poisson regression models to assess the risk of developing CLABSI as a function of PICC dwell time. We compared diagnoses and treatment characteristics between 2013–2015 and 2015–2020.Results455 PICCs placed in 370 patients were included, comprising 19,063 catheter days. Median indwelling time was 26 days (range 0–385) and CLABSI incidence was 4.0 per 1000 catheter days, with a median time to CLABSI of 33 days (range 18–158). Aplastic anaemia (AA) was associated with an increased risk of CLABSI; patients undergoing autologous stem cell transplantation (SCT) were less likely to develop CLABSI. In the unadjusted analysis, PICCs with an indwelling time of 15–28 days, 29–42 days, 43–56 days and > 56 days each had an increased CLABSI incidence rate ratio of 2.4 (1.2–4.8), 2.2 (0.95–5.0), 3.4 (1.6–7.5) and 1.7 (0.9–3.5), respectively, compared to PICCs in place for < 15 days. However, after adjusting for AA and SCT, there was no significant difference in incidence rates between dwell times (p 0.067).ConclusionsOur study shows that risk of CLABSI does not appear to increase with longer PICC indwelling time. Routine replacement of PICCs therefore is unlikely to prevent CLABSI in this population.

Sustainable Neonatal CLABSI Surveillance: Consensus Toward New Criteria in the Netherlands

Group Name: Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric SocietyBackground: Central-line–associated bloodstream infections (CLABSIs) are a main focus of infection prevention and control initiatives in neonatal care. Standardized surveillance of neonatal CLABSI enables intra- and interfacility comparisons, which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands. Across neonatal intensive care units (NICUs), several different sets of CLABSI criteria and surveillance methods are used for local monitoring of CLABSI incidence rates. To achieve standardized CLABSI surveillance, we conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria. Method: A modified Delphi consensus procedure for the development of nationwide neonatal CLABSI surveillance criteria was performed between January 2016 and January 2017 in the Netherlands. An expert panel was formed by members of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society. The consensus procedure consisted of 3 expert panel rounds. Figure 1 shows a detailed description of the consensus procedure. Result: The expert panel achieved consensus on Dutch neonatal CLABSI surveillance criteria, which are summarized in Figure 2. Neonatal CLABSI is defined as a bloodstream infection occurring &gt;72 hours after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by 1 or more blood cultures. In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: (1) a bacterial or fungal pathogen is identified from 1 or more blood cultures; (2) the patient has clinical symptoms of sepsis and (2A) a common commensal is identified in 2 separate blood cultures or (2B) a common commensal is identified by 1 blood culture and C-reactive protein (CRP) level is &gt;10 mg/L in the first 36 hours following blood culture collection. Conclusion: The newly developed Dutch neonatal CLABSI surveillance criteria are concise, are specific to the neonatal population, and comply with a single blood-culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI surveillance criteria is needed to identify best practices for infection prevention and control.Funding: NoDisclosures: None

Does continuity in nursing staff matter? A pilot study on correlation of central line-associated bloodstream infections and employee turnover

BackgroundUnderstaffing has been previously reported as a risk factor for central line-associated bloodstream infections (CLABSI). No previous study addressed the question whether fluctuations in staffing have an impact on CLABSI incidence. We analyzed prospectively collected CLABSI surveillance data and data on employee turnover of health care workers (HCW) to address this research question.MethodsIn January 2016, a semiautomatic surveillance system for CLABSI was implemented at the University Hospital Zurich, a 940 bed tertiary care hospital in Switzerland. Monthly incidence rates (CLABSI/1000 catheter days) were calculated and correlations with human resources management-derived data on employee turnover of HCWs (defined as number of leaving HCWs per month divided by the number of employed HCWs) investigated.ResultsOver a period of 24 months, we detected on the hospital level a positive correlation of CLABSI incidence rates and turnover of nursing personnel (Spearman rank correlation, r = 0.467, P = 0.022). In more detailed analyses on the professional training of nursing personnel, a correlation of CLABSI incidence rates and licensed practical nurses (Spearman rank correlation, r = 0.26, P = 0.038) or registered nurses (r = 0.471, P = 0.021) was found. Physician turnover did not correlate with CLABSI incidence (Spearman rank correlation, r = −0.058, P = 0.787).ConclusionsProspectively determined CLABSI incidence correlated positively with the degree of turnover of nurses overall and nurses with advanced training, but not with the turnover of physicians. Efforts to maintain continuity in nursing staff might be helpful for sustained reduction in CLABSI rates.

Incidence Trends of Central-Line–Associated Bloodstream Infections in Neonatal Intensive Care Units, NHSN, 2009–2018

Background: Central-line–associated bloodstream infections (CLABSIs) are a major source of healthcare-associated infections (HAIs) in neonatal intensive care unit (NICU) patients, and they are associated with increased morbidity, mortality, and costs. CLABSI surveillance has been a critical component for hospitals participating in the Center for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) for many years. CLABSI reporting grew substantially as a result of state reporting mandates first introduced in 2005 and federal reporting requirements for all intensive care units that began in 2011. However, no recent assessment of NHSN CLABSI incidence rate changes have been performed. The objective of this analysis was to estimate the overall trends in annual CLABSI incidence rates in NICUs from 2009 to 2018. Methods: We analyzed NHSN CLABSI data reported from NICUs during 2009–2018. CLABSIs further classified as mucosal barrier injury were included in this analysis. To evaluate the trends of CLABSI incidence (per 1,000 central-line days), and to account for the potential impact of definition changes introduced in 2015, we conducted an interrupted time-series analysis using mixed-effects negative binomial regression modeling. Birth weight category, patient care location type and hospital-level characteristics such as hospital type, medical affiliation, teaching status, bed size, and average length of inpatient stay) were assessed as potential covariates in regression analysis. Random intercept and slope models were evaluated with covariance tests and used to account for differential baseline incidence and trends among reporting NICUs. Results: The number of NICUs reporting to NHSN increased significantly following the federal mandate and has remained slightly &gt;1,000 NICUs since 2013. The crude incidence of CLABSI dropped from 2.24 in 2009 to 0.98 infections per 1,000 central-line days in 2018, except for an increase in 2015 (Table 1). The CLABSI incidence, adjusted for birth weight category, decreased by an average of 11.6% per year from 2009 to 2018 except for a 35.8% increase in 2015 (Table 2). Conclusion: These findings suggest that hospitals have made significant strides in reducing the occurrence of CLABSIs in NICUs over the last 10 years. The increase in 2015 could be explained in part by the implementation and application of new definitional changes. Continued practices and policies that target, assess and prevent CLABSI in this setting may have been effective and remain vital to sustaining this decline nationally in subsequent years.Funding: NoneDisclosures: None

Incidence Trends of Central-Line–Associated Bloodstream Infections in Acute-Care Hospitals, NHSN, 2009–2018

Background: Central-line–associated bloodstream infections (CLABSIs) are an important cause of healthcare-associated morbidity and mortality in the United States. CLABSI surveillance in the CDC NHSN began in 2005 and has been propelled by state CLABSI reporting requirements, first introduced in 2005, and subsequently by the CMS requirements for intensive care units (ICUs) in 2011 and select ward locations in 2015. Although trend analyses were previously reported, no recent assessment of the NHSN CLABSI incidence rate changes has been performed. In this analysis, we evaluated trends in CLABSI rates in nonneonatal ICUs and all wards reported from acute-care hospitals. Methods: CLABSI rates, including blood stream infections attributed to mucosal barrier injury reported to the NHSN from 2009 to 2018, were analyzed. To evaluate trends in CLABSI incidence and to account for the potential impact of definitional changes in catheter-associated urinary tract infections (CAUTIs) that indirectly impacted CLABSI rates, as well as the CMS mandate for select wards, we conducted an interrupted time-series analysis using negative binomial random-effects modeling with an interruption in 2015. ICUs and ward locations were analyzed separately. Models were adjusted for patient care location type and hospital-level characteristics: hospital type, medical affiliation, teaching status, bed size, number of ICU beds, and average length of inpatient stay. Random intercept and slope models were used to account for differential baseline incidence and trends among reporting hospitals. Results: The overall crude incidence of CLABSI per 1,000 central-line days decreased from 1.6 infections in 2009 to 0.9 infections in 2018, except for an increase in 2015. Similar trends were observed by location type. Among the ICUs, adjusted CLABSI incidence decreased by 10% annually in 2009–2014, increased nearly 29% in 2015, and thereafter decreased at an average of 6.8% per year. Among the wards, adjusted CLABSI incidence decreased at an average of 7.9% annually, except for a 29.3% increase in 2015. Conclusions: Substantial progress has been made in reducing CLABSIs in both ICUs and wards over the last 10 years. Indirect effects of CAUTI definitional changes may explain the immediate increase in ICUs, whereas the CMS mandate may explain the similar increase in wards in 2015. Despite this increase, these findings suggest that policies and practices aimed at prevention of CLABSI have likely been effective on a national level.Funding: NoneDisclosures: None

1179. Rates and Causative Pathogens of Device-Associated Bloodstream and Urinary Tract Infections Attributed to Solid-Organ Transplant Units, 2015–2017

BackgroundDue to complex invasive medical procedures and compromised immunity, solid-organ transplant (SOT) patients are at high risk for infections. However, whether SOT patients are at higher risk than other hospitalized patients for selected healthcare-associated infections (HAI), such as central line-associated bloodstream infections (CLABSI) or catheter-associated urinary tract infections (CAUTI), or for infections with antimicrobial-resistant (AR) pathogens, is not well described. We analyzed data reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) from inpatient SOT units and compared CLABSI and CAUTI rates and AR in hospitals with both SOT and non-SOT units.MethodsWe analyzed 2015–2017 CLABSI and CAUTI data reported to NHSN from hospitals with adult or pediatric inpatient SOT units. We calculated CLABSI and CAUTI incidence rates per 1,000 central-line days (CLD) and urinary catheter days (UCD), respectively, and compared rates, pathogen distributions, and AR among events attributed to three unit types: (1) SOT units; (2) adult, pediatric, and neonatal critical care units; and (3) adult and pediatric medical, surgical, and combined medical-surgical wards. We compared proportions using χ 2 tests and determined statistical significance at P ≤ 0.05.ResultsCLABSI and CAUTI rates in SOT units were lower than rates in critical care units, but higher than rates in wards (table). Although the most common CLABSI and CAUTI pathogens were similar in all three unit types, the prevalence of individual pathogens differed (figure). Among CLABSI pathogens, Enterococcus faecium, Escherichia coli, and Klebsiella pneumoniae or oxytoca were significantly more prevalent in SOT compared with critical care units. Vancomycin resistance among CLABSI E. faecium was significantly lower (71.4% vs. 87.5%) and fluoroquinolone resistance among CAUTI E. coli was significantly higher (49.3% vs. 32.5%) in SOT compared with critical care units.ConclusionSOT units have lower CLABSI and CAUTI rates compared with critical care units. Differences in pathogens and AR among device-associated HAIs in SOT units should be considered when implementing infection prevention and treatment policies. Disclosures All authors: No reported disclosures.

'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs.

The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

Repair of damaged central venous catheters is safe and doubles catheter survival: a home parenteral nutrition patient cohort study

Repeated central venous catheter loss due to complications, including material breakage, compromises the options to obtain adequate vascular access in home parenteral nutrition (HPN) patients. It remains unclear whether repair of damaged catheters is an effective strategy to extend catheter survival, avoid surgical replacement and maintain venous access. The aim of this study was to evaluate the effectiveness and safety of catheter repair in our cohort of intestinal failure patients. We conducted a retrospective analysis of all catheter repairs that were performed between 2006 and 2017at our tertiary referral centre for intestinal failure. Primary outcome was the additional median catheter survival after catheter repair, as calculated with Kaplan-Meier analyses. Secondary outcomes included risk for central line-associated bloodstream infections (CLABSIs) and risk factors for catheter damage, as calculated with Poisson regression analyses. CLABSI rates in post-repair periods were compared with pre-repair periods. Pre- and post-repair periods were either short-term (30 days), or long-term (whole catheter period). A total of 58 repairs in 41 catheters of 35 HPN patients were included in the analysis. The median time to first repair was 452 days (interquartile range (IQR) 206-1134). After first repair, catheter survival additionally increased by 510 days (IQR 147-1195). Repairs did not increase the short-term risk for CLABSIs: incidence rates were 1.23 and 1.26 CLABSIs/1000 catheter days for the 30 days pre- and post-repair periods, respectively (rate ratio, 1.05; 95%CI, 0.15-7.44; P=0.96). For the whole pre- and post-repair catheter period, incidence rates were 0.12 and 0.59 CLABSIs/1000 catheter days, respectively (rate ratio, 3.55; 95%CI, 1.10-11.45; P=0.03). The overall CLABSI incidence rates in undamaged versus repaired catheters were 0.84 and 0.31 CLABSIs/1000 catheter days, respectively (rate ratio, 0.47; 95%CI, 0.23-0.94; P=0.03). A lower age at catheter start and femoral catheterization were associated with a higher risk for catheter damage. Repair of damaged catheters is often successful and an effective strategy to prolong and maintain venous access in HPN patients. On the short-term, no increase in CLABSI incidence was observed. Despite a possible increase in CLABSI incidence on the long-term, overall CLABSI rates of repaired catheters remained well below the overall CLABSI incidence of undamaged catheters. Theidentification of two risk factors for catheter damage may help to prevent future catheter damage.

Risk factors for vascular catheter-related bloodstream infections in pediatric intensive care units.

ObjectivesTo determine the risk factors for acquiring central line-associated blood stream infections (CLABSI) in pediatric intensive care units and to investigate the incidence and etiology of CLABSI in pediatric intensive care units with different profiles.MethodsThe study was a prospective cohort study in three hospitals. One of the hospitals is a large metropolitan public hospital with two pediatric intensive care units and a total of nineteen pediatric intensive care unit beds, another is a regional hospital with eight pediatric intensive care unit beds, and the third is a private hospital with fifteen beds. Patients between the ages of 1 month old and 18 years old who used a central venous catheter for over 24 hours were included. We recorded patients’ daily progress. General patient and catheter-related data were collected and used as variables. All the data were analyzed using Statistical Package for Social Science (SPSS), version 13.0, to compare patients with CLABSI with or without risk factors.ResultsA total of 728 patients were admitted to the pediatric intensive care units, and 170 had a central line in place for at least 24 hours. The median age was 32 months, and 97 (57%) of the patients were males. The CLABSI incidence rate was 3.9/1000 central venous catheter-days. The incidence among hospitals varied from 1.6 to 6.6. The overall mortality rate was 11.1%, and the CLABSI and non-CLABSI mortality rates were 12.9% and 10.7%, respectively. In multivariate analysis, independent risk factors for CLABSI were a longer duration of central venous catheter use (OR: 1.07; 95%CI 1.00 - 1.14; p = 0.019) and the use of more than one central venous catheter at once (OR: 2.59; 95%CI 1.17 - 5.73; p = 0.048).ConclusionA longer duration of central venous catheter use and the use of more than one central venous catheter at once were the main risk factors for CLABSI in pediatric intensive care units.

The epidemiology, antibiograms and predictors of mortality among critically-ill patients with central line-associated bloodstream infections.

For high risk of central line-associated bloodstream infections (CLABSIs) in patients of intensive care units (ICUs) and scarcely epidemiology and therapeutic recommendations in Asia, we aimed to evaluate the annual change in epidemiology, antibiogram, and risk factors for 14-day mortality. A retrospective study of ICUs patients with CLABSIs at a medical center in Taiwan (2010-2016), where central line care bundle implemented since 2014, by reviewing clinical data, pathogens, and the antibiogram. Gram-negative bacteria (59.3%) were main microorganisms of CLABSIs, and 9.0% of all GNB were MDROs. Acinetobacter spp., Enterobacter spp., and Stenotrophomonas maltophilia were the most frequently isolated. In multivariate analysis, malignancy, inadequate empirical antimicrobial therapy, inadequate definite antimicrobial therapy, and infection by fungi or multidrug-resistant organisms (MDROs) were associated with 14-day mortality (all p<0.05). The CLABSI incidence rate decreased from 5.54 to 2.18 per 1000 catheter-day (from 2014 to 2015) with improved compliance to care bundle. Carbapenem and aminoglycoside were suitable empirical drugs in the hospital setting when GNB is predominant for CLABSI. Significant decreasing susceptibility of ampicillin/sulbactam in Enterobacter spp. (36.7%-0.0%), and ampicillin/sulbactam (12.5%-0.0%), ceftazidime (100.0%-52.9%), and tigecycline (87.5%-35.3%) in Serratia marcescens. We identified Gram-negative bacteria as leading pathogens of CLABSIs in a Taiwan medical center, and good compliance to care bundle is associated with reduced CLABSI incidence rate. Malignancy, infection by MDROs or fungi, inadequate empirical or definite antimicrobial therapy are significant factors for 14-day mortality.

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study.

Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan–Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25–5.41], male gender (HR 2.63, 95% CI 1.17–5.90), and higher birth weight (HR 1.04, 95% CI 1.002–1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12–0.52) was associated with a decreased risk. Conclusion: In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.

Central-line associated bloodstream infections in a tertiary care children's University hospital: a prospective study.

BackgroundThe central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children’s university hospital.MethodsThe study involved all children aged less than 18 years admitted to Meyer Children’s University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant.ResultsCLABSI rate was 3.73/1000 (95% CI: 2.54–5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum β-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae.ConclusionsOur study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.

Effect of central line bundle implementation on central line-associated bloodstream infection rates in NICU in KSA

Central Line-Associated Bloodstream Infections (CLABSI) remained a significant cause of mortality and morbidity in neonatal patients admitted to the neonatal ICU (NICU) who require central line insertion for whatever medical reason. Recent introduction of Central line bundle strategies was associated with a drop in the CLABSI rates. Data about the effect of central line bundle on the rate of CLABSI in neonatal patients in Saudi Arabia are lacking. In this prospective targeted surveillance study, we examined the association between central line bundle implementation and the incidence rate of CLABSI in a neonatal ICU in a tertiary teaching hospital in Saudi Arabia during the period between 2009 and 2011. We looked also at the rate of compliance with the CL bundle. The results showed a statistically significant decrease in umbilical catheter- related BSI rate (p= 0.048). Other types of central lines did not show any statistically significant association. The overall catheter utilization ratio was generally higher than that reported by the US National Healthcare Safety Network (NHSN). The overall CL bundle compliance was below the targeted rate adopted by the Institute for Healthcare Improvement (IHI). Further efforts towards increasing compliance with central line bundle strategies and reducing the use of central lines is needed to further decrease of the current rates of CLABSI in our NICU. Other factors contributing to the development of CLABSI, which were not explored in this study, need to be examined as well.

Effect of central line bundle implementation on central line-associated bloodstream infection rates in NICU in KSA

Central Line-Associated Bloodstream Infections (CLABSI) remained a significant cause of mortality and morbidity in neonatal patients admitted to the neonatal ICU (NICU) who require central line insertion for whatever medical reason. Recent introduction of Central line bundle strategies was associated with a drop in the CLABSI rates. Data about the effect of central line bundle on the rate of CLABSI in neonatal patients in Saudi Arabia are lacking. In this prospective targeted surveillance study, we examined the association between central line bundle implementation and the incidence rate of CLABSI in a neonatal ICU in a tertiary teaching hospital in Saudi Arabia during the period between 2009 and 2011. We looked also at the rate of compliance with the CL bundle. The results showed a statistically significant decrease in umbilical catheter- related BSI rate (p= 0.048). Other types of central lines did not show any statistically significant association. The overall catheter utilization ratio was generally higher than that reported by the US National Healthcare Safety Network (NHSN). The overall CL bundle compliance was below the targeted rate adopted by the Institute for Healthcare Improvement (IHI). Further efforts towards increasing compliance with central line bundle strategies and reducing the use of central lines is needed to further decrease of the current rates of CLABSI in our NICU. Other factors contributing to the development of CLABSI, which were not explored in this study, need to be examined as well.

A survey of preventive measures used and their impact on central line-associated bloodstream infections (CLABSI) in intensive care units (SPIN-BACC).

BackgroundThe Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CLABSI incidence rates.MethodsAll hospitals participating in the Quebec healthcare-associated infections surveillance program (SPIN-BACC – n = 48) received a 77-question survey about preventive measures implemented and monitored in their ICU. The questionnaire was validated for construct, content, face validity, and reliability. We used Poisson regression to measure the association between compliance monitoring to preventive measures and CLABSI rates.ResultsForty-two (88%) eligible hospitals completed the survey. Two components from the maximum barrier precautions were used less optimally: cap (88%) and full sterile body drape (71%). Preventive measures reported included daily review of catheter need (79%) and evaluation of insertion site for the presence of inflammation (90%). Two hospitals rewired lines even if an infection was suspected or documented.In adult ICUs, there was a statistically significant greater decrease in CLABSI rates in ICUs that monitored compliance to preventive insertion measures, after adjusting for teaching status and the number of hospital beds (p = 0.036).ConclusionsHospitals participating to the SPIN-BACC program follow recommendations for CLABSI prevention, but only a minority locally monitor their application. Compliance monitoring of preventive measures for catheter insertion was associated with a decrease in CLABSI incidence rates.