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A ten-year review of healthcare-associated bloodstream infections from forty hospitals in Québec, Canada

Published online by Cambridge University Press:  29 August 2018

Iman Fakih ,
Élise Fortin ,
Marc-André Smith ,
Alex Carignan ,
Claude Tremblay ,
Jasmin Villeneuve ,
Danielle Moisan ,
Charles Frenette ,
Caroline Quach Open the ORCID record for Caroline Quach [Opens in a new window]  and
for SPIN-BACTOT
Iman Fakih
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada
Élise Fortin
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada
Marc-André Smith
Affiliation:
CIUSSS du Nord-de-l’Île-de-Montréal, Québec, Canada
Alex Carignan
Affiliation:
Department of Microbiology and Infectious Diseases, Sherbrooke University, Québec, Canada
Claude Tremblay
Affiliation:
CHU de Québec, Québec, Canada
Jasmin Villeneuve
Affiliation:
Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada
Danielle Moisan
Affiliation:
CISS du Bas-Saint-Laurent, Québec, Canada
Charles Frenette
Affiliation:
Department of Medical Microbiology, McGill University Health Centre, Québec, Canada
Caroline Quach*
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Québec, Canada
for SPIN-BACTOT
Affiliation:
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Québec, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Québec, Canada CIUSSS du Nord-de-l’Île-de-Montréal, Québec, Canada Department of Microbiology and Infectious Diseases, Sherbrooke University, Québec, Canada CHU de Québec, Québec, Canada CISS du Bas-Saint-Laurent, Québec, Canada Department of Medical Microbiology, McGill University Health Centre, Québec, Canada Division of Pediatric Infectious Diseases and Medical Microbiology, CHU Sainte-Justine, Québec, Canada
*
Author for correspondence: Caroline Quach, CHU Sainte-Justine, 3175 ch Côte Sainte-Catherine, Suite B.17.102, Montréal, QC H3T 1C5. E-mail: [email protected]
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Abstract

Objective

Healthcare-associated bloodstream infections (HABSI) are a significant cause of morbidity and mortality worldwide. In Québec, Canada, HABSI arising from acute-care hospitals have been monitored since April 2007 through the Surveillance des bactériémies nosocomiales panhospitalières (BACTOT) program, but this is the first detailed description of HABSI epidemiology.

Methods

This retrospective, descriptive study was conducted using BACTOT surveillance data from hospitals that participated continuously between April 1, 2007, and March 31, 2017. HABSI cases and rates were stratified by hospital type and/or infection source. Temporal trends of rates were analyzed by fitting generalized estimating equation Poisson models, and they were stratified by infection source.

Results

For 40 hospitals, 13,024 HABSI cases and 23,313,959 patient days were recorded, for an overall rate of 5.59 per 10,000 patient days (95% CI, 5.54–5.63). The most common infection sources were catheter-associated BSIs (23.0%), BSIs secondary to a urinary focus (21.5%), and non–catheter-associated primary BSIs (18.1%). Teaching hospitals and nonteaching hospitals with ICUs often had rates higher than nonteaching hospitals without ICUs. Annual HABSI rates did not exhibit statistically significant changes from year to year. Non–catheter-associated primary BSIs were the only HABSI type that exhibited a sustained change across the 10 years, increasing from 0.69 per 10,000 patient days (95% CI, 0.59–0.80) in 2007–2008 to 1.42 per 10,000 patient days (95% CI, 1.27–1.58) in 2016–2017.

Conclusions

Despite ongoing surveillance, overall HABSI rates have not decreased. The effect of BACTOT participation should be more closely investigated, and targeted interventions along alternative surveillance modalities should be considered, prioritizing high-burden and potentially preventable BSI types.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 10 , October 2018 , pp. 1202 - 1209
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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