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Pathogens causing central-line–associated bloodstream infections in acute-care hospitals—United States, 2011–2017

Published online by Cambridge University Press:  09 January 2020

Shannon A. Novosad ,
Lucy Fike ,
Margaret A. Dudeck ,
Katherine Allen-Bridson ,
Jonathan R. Edwards ,
Chris Edens ,
Ronda Sinkowitz-Cochran ,
Krista Powell  and
David Kuhar
Shannon A. Novosad*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lucy Fike
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Margaret A. Dudeck
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Katherine Allen-Bridson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Chris Edens
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Ronda Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Krista Powell
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Kuhar
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Shannon Novosad, E-mail: [email protected]
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Abstract

Objective:

To describe pathogen distribution and rates for central-line–associated bloodstream infections (CLABSIs) from different acute-care locations during 2011–2017 to inform prevention efforts.

Methods:

CLABSI data from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) were analyzed. Percentages and pooled mean incidence density rates were calculated for a variety of pathogens and stratified by acute-care location groups (adult intensive care units [ICUs], pediatric ICUs [PICUs], adult wards, pediatric wards, and oncology wards).

Results:

From 2011 to 2017, 136,264 CLABSIs were reported to the NHSN by adult and pediatric acute-care locations; adult ICUs and wards reported the most CLABSIs: 59,461 (44%) and 40,763 (30%), respectively. In 2017, the most common pathogens were Candida spp/yeast in adult ICUs (27%) and Enterobacteriaceae in adult wards, pediatric wards, oncology wards, and PICUs (23%–31%). Most pathogen-specific CLABSI rates decreased over time, excepting Candida spp/yeast in adult ICUs and Enterobacteriaceae in oncology wards, which increased, and Staphylococcus aureus rates in pediatric locations, which did not change.

Conclusions:

The pathogens associated with CLABSIs differ across acute-care location groups. Learning how pathogen-targeted prevention efforts could augment current prevention strategies, such as strategies aimed at preventing Candida spp/yeast and Enterobacteriaceae CLABSIs, might further reduce national rates.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 3 , March 2020 , pp. 313 - 319
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: Preliminary data were presented as an oral abstract at the SHEA Annual Meeting in Portland, Oregon, on April 19, 2018.

References

Magill, SS, O’Leary, E, Janelle, SJ, et al.Changes in prevalence of health care-associated infections in US hospitals. N Engl J Med 2018;379:1732–1744.CrossRefGoogle Scholar
Infections avoided, excess costs averted, and changes in mortality rate. Agency for Healtchare Research Quality website. https://www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4c.html. Accessed December 3, 2019.Google Scholar
Goudie, A, Dynan, L, Brady, PW, Rettiganti, M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:e1525–e1532.CrossRefGoogle ScholarPubMed
Scott, RD. The direct medical costs of healthcare-associted infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf, 2009. Accessed June 21, 2018.Google Scholar
Stevens, V, Geiger, K, Concannon, C, Nelson, RE, Brown, J, Dumyati, G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.CrossRefGoogle ScholarPubMed
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central-line–associated bloodstream infection: systematic review and meta-analysis. Infection 2015;43:29–36.CrossRefGoogle ScholarPubMed
Operational guidance for acute care hospitals to report central line-associated bloodstream infection (CLABSI) data to the CDC NHSN for the purpose of fulfilling the CMS Hospital Inpatient Quality Reporting (IQR) requirements. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/FINAL-ACH-CLABSI-Guidance.pdf. Accessed June 21, 2018.Google Scholar
The Operational Guidance for Acute Care Hospitals to Report Central Line-Associated Bloodstream Infection (CLABSI) Data to CDC’s NHSN for the Purpose of Fulfilling CMS’s Hospital Inpatient Quality Reporting (IQR) Requirements.  https://www.cdc.gov/nhsn/pdfs/cms/Final-ACH-CLABSI-Guidance-2015.pdf. Accessed June 21, 2018.Google Scholar
Marschall, J, Mermel, LA, Fakih, M, et al.Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiology 2014;35:753–771.CrossRefGoogle ScholarPubMed
O’Grady, NP, Alexander, M, Burns, LA, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.CrossRefGoogle ScholarPubMed
Blot, K, Bergs, J, Vogelaers, D, Blot, S, Vandijck, D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis 2014;59:96–105.CrossRefGoogle ScholarPubMed
Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PloS One 2011;6:e15452.CrossRefGoogle ScholarPubMed
Marra, AR, Cal, RG, Durao, MS, et al.Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era. Am J Infect Control 2010;38:434–439.CrossRefGoogle ScholarPubMed
Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al.Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ (Clin Res) 2010;340:c309.CrossRefGoogle ScholarPubMed
2014 national and state healthcare-associated infections progress report. https://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Accessed June 21, 2018.Google Scholar
2017 National and State Healthcare-Associated Infections Progress Report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Accessed May 13, 2019.Google Scholar
Surveillance for bloodstream infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/acute-care-hospital/clabsi/index.html. Accessed June 21, 2018.Google Scholar
National Health Safety Network v 8.3 (January 2015) release notes. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/commup/Release-Notes-8_3_FINAL.pdf. Accessed June 21, 2018.Google Scholar
CDC locations and descriptions and instructions for mapping patient care locations. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdf. Accessed June 21, 2018.Google Scholar
Wittekamp, BH, Plantinga, NL, Cooper, BS, et al.Decontamination strategies and bloodstream infections with antibiotic-resistant microorganisms in ventilated patients: a randomized clinical trial. JAMA 2018 27;320:2087–2098.CrossRefGoogle ScholarPubMed
Frencken, JF, Wittekamp, BHJ, Plantinga, NL, et al.Associations between enteral colonization with gram-negative bacteria and intensive care unit-acquired infections and colonization of the respiratory tract. Clin Infect Dis 2018;66:497–503.CrossRefGoogle ScholarPubMed
Cassir, N, Thomas, G, Hraiech, S, et al.Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria. Am J Infect Control 2015;43:640–643.CrossRefGoogle ScholarPubMed
Lin, MY, Lolans, K, Blom, DW, et al.The effectiveness of routine daily chlorhexidine gluconate bathing in reducing Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae skin burden among long-term acute-care hospital patients. Infect Control Hosp Epidemiol 2014;35:440–442.CrossRefGoogle ScholarPubMed
Patel, A, Parikh, P, Dunn, AN, et al.Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: a meta-analysis. Infect Control Hosp Epidemiol 2019;40:392–399.CrossRefGoogle ScholarPubMed
Nucci, Marcio, Anaissie, Elias. Revisiting the source of candidemia: skin or gut? Clin Infect Dis 2001;33:1959–1967.CrossRefGoogle ScholarPubMed
Piedrahita, CT, Cadnum, JL, Jencson, AL, Shaikh, AA, Ghannoum, MA, Donskey, CJ. Environmental surfaces in healthcare facilities are a potential source for transmission of Candida auris and Other Candida Species. Infect Control Hosp Epidemiol 2017;38:1107–1109.CrossRefGoogle ScholarPubMed
Infection prevention and control for Candida auris. Centers for Disease Control and Prevention website. https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html. Accessed May 13, 2019.Google Scholar
Fagan, RP, Edwards, JR, Park, BJ, Fridkin, SK, Magill, SS. Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990–2010. Infect Control Hosp Epidemiol 2013;34:893–899.CrossRefGoogle ScholarPubMed
Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997–2007. JAMA 2009;301:727–736.CrossRefGoogle ScholarPubMed
Li, L, Fortin, E, Tremblay, C, et al.Hospital-acquired methicillin-resistant Staphylococcus aureus bloodstream infections in Québec: impact of guidelines. Infect Control Hosp Epidemiol 2017;38:840–847.CrossRefGoogle ScholarPubMed
Bender, JM, Virgallito, M, Newland, JG, et al.Infection prevention and control practices in children’s hospitals. Infect Control Hosp Epidemiol 2015;36:597–600.CrossRefGoogle ScholarPubMed
Miller, MR, Niedner, MF, Huskins, WC, et al.National Association of Children’s Hospitals and Related Institutions Pediatric Intensive Care Unit Central Line-Associated Bloodstream Infection Quality Transformation Teams. Reducing PICU central-line–associated bloodstream infections: 3-year results. Pediatrics 2011;128:1077–1083.CrossRefGoogle ScholarPubMed
Edwards, JD, Herzig, CT, Liu, H, et al.Central-line–associated bloodstream infections in pediatric intensive care units: longitudinal trends and compliance with bundle strategies. Am J Infect Control 2015;43:489–493.CrossRefGoogle ScholarPubMed
Klieger, SB, Potter-Bynoe, G, Quach, C, Sandora, TJ, Coffin, SE. Beyond the bundle: a survey of central line-associated bloodstream infection prevention practices used in US and Canadian pediatric hospitals. Infect Control Hosp Epidemiol 2013;34:1208–1210.CrossRefGoogle ScholarPubMed
Huang, SS, Septimus, E, Kleinman, K, et al.Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.CrossRefGoogle ScholarPubMed
Septimus, EJ, Hayden, MK, Kleinman, K, et al.Does chlorhexidine bathing in adult intensive care units reduce blood culture contamination? A pragmatic cluster-randomized trial. Infect Control Hosp Epidemiol 2014;35 suppl 3:S17–S22.CrossRefGoogle ScholarPubMed
Boyce, JM, Nadeau, J, Dumigan, D, et al.Obtaining blood cultures by venipuncture versus from central lines: impact on blood culture contamination rates and potential effect on central line-associated bloodstream infection reporting. Infect Control Hosp Epidemiol 2013;34:1042–1047.CrossRefGoogle ScholarPubMed
Snyder, SR, Favoretto, AM, Baetz, RA, et al.Effectiveness of practices to reduce blood culture contamination: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012;45:999–1011.CrossRefGoogle ScholarPubMed
Kanamori, H, Weber, DJ, Rutala, WA. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis 2016;62:1423–1435.CrossRefGoogle ScholarPubMed
From plumbing to patients, water management plans for healthcare facilities. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/prevent/water-management.html. Accessed May 13, 2019.Google Scholar