Central line-associated bloodstream infections among critically-ill patients in the era of bundle care
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
50
Journal Issue
3
Pages
339-348
Date Issued
2017
Author(s)
Chang Y.-C.
Hung M.-C.
Hseuh P.-R.
Abstract
Background/Purpose Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-ill patients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-ill patients after implementation of bundle care. Methods Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days. Results The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18–1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02–1.20), respectively. Conclusion In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality. ? 2015
SDGs
Other Subjects
antiinfective agent; aged; aminotransferase blood level; antibiotic sensitivity; antimicrobial therapy; antisepsis; APACHE; Article; blood culture; Candida; candidiasis; cardiovascular disease; care bundle; catheter infection; catheter removal; Charlson Comorbidity Index; critically ill patient; diabetes mellitus; Enterococcus; female; fungus; glomerulus filtration rate; Gram negative bacterium; Gram positive bacterium; hand washing; hepatobiliary disease; hospitalization; human; immunosuppressive treatment; in vitro study; infection control practitioner; intensive care unit; kidney disease; major clinical study; male; morbidity; mortality; neurologic disease; practice guideline; respiratory tract disease; risk assessment; Taiwan; total parenteral nutrition; bacteremia; bacterium; care bundle; catheter infection; classification; critical illness; fungemia; incidence; isolation and purification; middle aged; procedures; prospective study; survival analysis; treatment outcome; very elderly; Aged; Aged, 80 and over; Bacteremia; Bacteria; Catheter-Related Infections; Critical Illness; Female; Fungemia; Fungi; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Patient Care Bundles; Prospective Studies; Survival Analysis; Taiwan; Treatment Outcome
Publisher
Elsevier Ltd
Type
journal article